Unplanned Readmissions in Pediatric Cardiac Disease: Impacts of Social Determinants of Health.

To investigate relationships between unplanned readmissions and social determinants of health in pediatric cardiac disease. Retrospective cohort study of pediatric (< 18 years) cardiac admissions in the Pediatric Health Information System (1/2019-3/2023). Social determinants included Child Opportunity Index (lower opportunity indicates fewer neighborhood-level resources), insurance, urbanicity, race, and ethnicity. Primary outcomes were unplanned all-cause and cardiac-related 90- and 365-day readmissions. Sub-analyses were performed in cardiac surgical and cardiac medical (congenital versus acquired) cohorts. Of 320,225 admissions, 90- and 365-day all-cause readmission rates were 22.0%, and 33.6% (cardiac-related: 13.8% and 20.9%). Cardiac-surgical patients accounted for 9.4% of readmissions. All-cause 90- and 365-day readmissions were higher among children with Hispanic/Latino ethnicity, Black/African American race, Medicaid, and low/very low opportunity (p < 0.001). Adjusted odds of 90-day readmissions were greater for children with Hispanic/Latino ethnicity (aOR 1.04[95%CI 1.01-1.07]), Medicaid insurance (aOR 1.17[1.14-1.19]), and urban residence (aOR 1.11[1.08-1.14]). At 365 days, odds were also higher for children with Multiracial backgrounds (aOR 1.07[1.01-1.14]) and residing in low/very low opportunity areas (aOR 1.08[1.03-1.12]). All-cause readmission findings were primarily driven by cardiac medical patients with less pronounced effects in surgical readmissions. All-cause readmission rates decreased as opportunity increased for children with Asian and White race but not other racial/ethnic backgrounds. Cardiac-related readmissions had similar results, except for lower readmissions in children with Black/African American race. Children with cardiac disease with fewer resources, public insurance, and underrepresented racial/ethnic backgrounds have more unplanned readmissions. The child opportunity index modified race-readmission relationships. Opportunities exist to optimize discharge planning, follow-up, and preventative care.