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The Association of Race and Ethnicity with Mortality in Pediatric Patients with Congenital Heart Disease: a Systematic Review

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Context

Congenital heart disease (CHD) is a common condition with high morbidity and mortality and is subject to racial and ethnic health disparities.

Objective

To conduct a systematic review of the literature to identify differences in mortality in pediatric patients with CHD based on race and ethnicity.

Data Sources

Legacy PubMed (MEDLINE), Embase (Elsevier), and Scopus (Elsevier)

Study Selection

English language articles conducted in the USA focused on mortality based on race and ethnicity in pediatric patients with CHD.

Data Extraction

Two independent reviewers assessed studies for inclusion and performed data extraction and quality assessment. Data extraction included mortality based on patient race and ethnicity.

Results

There were 5094 articles identified. After de-duplication, 2971 were screened for title and abstract content, and 45 were selected for full-text assessment. Thirty studies were included for data extraction. An additional 8 articles were identified on reference review and included in data extraction for a total of 38 included studies. Eighteen of 26 studies showed increased risk of mortality in non-Hispanic Black patients. Results were heterogenous in Hispanic patients with eleven studies of 24 showing an increased risk of mortality. Results for other races demonstrated mixed outcomes.

Limitations

Study cohorts and definitions of race and ethnicity were heterogenous, and there was some overlap in national datasets used.

Conclusion

Overall, racial and ethnic disparities existed in the mortality of pediatric patients with CHD across a variety of mortality types, CHD lesions, and pediatric age ranges. Children of races and ethnicities other than non-Hispanic White generally had increased risk of mortality, with non-Hispanic Black children most consistently having the highest risk of mortality. Further investigation is needed into the underlying mechanisms of these disparities so interventions to reduce inequities in CHD outcomes can be implemented.

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Data Availability

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Code availability

The search terms used for database search are available upon request.

Funding

This work was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R38HL143612 and by the Duke Center for Research to Advance Healthcare Equity (REACH Equity), which is supported by the National Institute on Minority Health and Health Disparities under award number U54MD012530.

Author information

Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, 2301 Erwin Road, DUMC Box 3127, Durham, NC, 27710, USA

    Meredith Sooy-Mossey, Jason L. Williams, Kathleen Wood & Jennifer S. Li

  2. Deparment of Pediatrics, Massachusetts General Hospital, Boston, MA, USA

    Mirai Matsuura

  3. Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada

    Jordan E. Ezekian

  4. Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

    Grace S. Lee

  5. Division of Cardiology, Columbia University Department of Medicine, New York, NY, USA

    Samantha Dizon

  6. Medical Center Library and Archives, Duke University, Durham, NC, USA

    Samantha J Kaplan

  7. Pediatric Hospital Medicine, Duke University School of Medicine, Durham, NC, USA

    Victoria Parente

Authors
  1. Meredith Sooy-Mossey
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  2. Mirai Matsuura
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  3. Jordan E. Ezekian
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  4. Jason L. Williams
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  5. Grace S. Lee
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  6. Kathleen Wood
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  7. Samantha Dizon
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  8. Samantha J Kaplan
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  9. Jennifer S. Li
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  10. Victoria Parente
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Contributions

All authors contributed to the study conception and design. Material preparation and data base search was performed by Samantha J. Kaplan. Data collection and analysis were performed by Meredith Sooy-Mossey, Mirai Matsuura, Jordan E. Ezekian, Jason L. Williams, Grace S. Lee, Kathleen Wood, and Samantha Dizon. Jennifer S. Li and Victoria Parente oversaw the study. The first draft of the manuscript was written by Meredith Sooy-Mossey, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Meredith Sooy-Mossey.

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Appendix Search Strategy Report:

Appendix Search Strategy Report:

Topic: Sociodemographic factors affect mortality in pediatric patients with congenital heart disease

Searcher: SJK

Date: 4.3.2020

Database (including vendor/platform):

Set #

 

Results

1

"Heart Defects, Congenital"[Mesh] OR ((congenital[tiab]) AND (heart[tiab] OR cardiac[tiab]) AND (disease[tiab] OR defect[tiab] OR defects[tiab] OR defective[tiab] OR abnormal[tiab] OR abnormality[tiab] OR abnormalities[tiab] OR malformed[tiab] OR malformation[tiab] OR malformations[tiab] OR surgery[tiab] OR surgeries[tiab] OR surgical[tiab])) OR CHD[tiab] OR CHDs[tiab]

190052

2

Mortality[sh] OR mortality[tiab] OR mortalities[tiab]

1100590

OR

((Mortality[sh] OR mortality[tiab] OR mortalities[tiab]) OR death[tiab] OR deaths[tiab] OR dying[tiab] OR died[tiab] OR die[tiab])

1883398

3

("Child"[Mesh] OR "Infant"[Mesh] OR "Adolescent"[Mesh] OR "Pediatrics"[Mesh] OR "Minors"[Mesh] OR "Puberty"[Mesh] OR infant[tiab] OR infants[tiab] OR infancy[tiab] OR newborn[tiab] OR newborns[tiab] OR neonatal[tiab] OR neonate[tiab] OR neonates[tiab] OR baby[tiab] OR babies[tiab] OR preterm[tiab] OR prematurity[tiab] OR toddler[tiab] OR toddlers[tiab] OR boy[tiab] OR boys[tiab] OR boyhood[tiab] OR girl[tiab] OR girls[tiab] OR girlhood[tiab] OR kid[tiab] OR kids[tiab] OR child[tiab] OR childhood[tiab] OR children[tiab] OR schoolchild[tiab] OR schoolgirl[tiab] OR schoolgirls[tiab] OR schoolboy[tiab] OR schoolboys[tiab] OR "school age"[tiab] OR "school aged"[tiab] OR preadolescent[tiab] OR preadolescents[tiab] OR preadolescence[tiab] OR adolescent[tiab] OR adolescents[tiab] OR adolescence[tiab] OR juvenile[tiab] OR juveniles[tiab] OR youth[tiab] OR youths[tiab] OR teen[tiab] OR teens[tiab] OR teenager[tiab] OR teenagers[tiab] OR teenaged[tiab] OR puberty[tiab] OR pubescent[tiab] OR pubescence[tiab] OR prepubescent[tiab] OR prepubescence[tiab] OR pediatric[tiab] OR pediatrics[tiab] OR paediatric[tiab] OR paediatrics[tiab] OR minors[tiab])

4231675

4

"Ethnic Groups"[Mesh] OR "Minority Health"[Mesh] OR "Race Factors"[Mesh] OR "Hispanic Americans"[Mesh] OR "Mexican Americans"[Mesh] OR "African Americans"[Mesh] OR "Asian Continental Ancestry Group"[Mesh] OR "Asian Americans"[Mesh] OR "Oceanic Ancestry Group"[Mesh] OR "American Native Continental Ancestry Group"[Mesh] OR "Arabs"[Mesh] OR "Amish"[Mesh] OR "Jews"[Mesh] OR "Roma"[Mesh] OR "Indigenous Peoples"[Mesh] OR "Socioeconomic factors"[Mesh] OR "Social Class"[Mesh] OR "Cost of Illness"[Mesh] OR "Poverty"[Mesh] OR "Education"[Mesh] OR "education" [Subheading] OR "Educational Status"[Mesh] OR "Education of Hearing Disabled"[Mesh] OR "Education of Visually Disabled"[Mesh] OR "Sex Education"[Mesh] OR "Literacy"[Mesh] OR "Information Literacy"[Mesh] OR "Health Literacy"[Mesh] OR "Computer Literacy"[Mesh] OR Hispanic[tiab] OR Mexican[tiab] OR Hispanics[tiab] OR Mexicans[tiab] OR Cuban[tiab] OR Cubans[tiab] OR Latin[tiab] OR Latina[tiab] OR Latinas[tiab] OR Latino[tiab] OR Latinos[tiab] OR Latinx[tiab] OR "Latin American"[tiab] OR "Latin-American"[tiab] OR "Latin Americans"[tiab] OR "Latin-Americans"[tiab] OR "Spanish speaking"[tiab] OR "Spanish-speaking"[tiab] OR "Spanish speakers"[tiab] OR "Spanish-speakers"[tiab] OR (Spanish[tiab] AND (speakers[tiab] OR speaker[tiab] OR speaking[tiab] OR language[tiab])) OR "Puerto Rico"[tiab] OR "Puerto Rican"[tiab] OR "Puerto Ricans"[tiab] OR black[tiab] OR blacks[tiab] OR "African-American"[tiab] OR "African American"[tiab] OR "African-Americans"[tiab] OR "African Americans"[tiab] OR Black[tiab] OR Blacks[tiab] OR racial[tiab] OR race[tiab] OR racism[tiab] OR colorism[tiab] OR shadeism[tiab] OR ethnic[tiab] OR ethnicity[tiab] OR ethnicities[tiab] OR minority[tiab] OR minorities[tiab] OR indigenous[tiab] OR ((Native[tiab] OR natives[tiab] OR indian[tiab] OR Indians[tiab]) AND (American[tiab] OR Americans[tiab] OR Alaskan[tiab] OR Alaskans[tiab] OR Alaska[tiab] OR Hawaiian[tiab] OR Hawaiians[tiab])) OR "Pacific Islander"[tiab] OR "Pacific Islanders"[tiab] OR Arabs[tiab] OR Arab[tiab] OR Arabic[tiab] OR Palestinian[tiab] OR Indigenous[tiab] OR "First Nation"[tiab] OR Native[tiab] OR Oceanic[tiab] OR Socioeconomic[tiab] OR "socio-economic"[tiab] OR socioeconomically[tiab] OR "economic burden"[tiab] OR "financial burden"[tiab] OR "travel burden"[tiab] OR "cost of illness"[tiab] OR "cost of sickness"[tiab] OR "cost of disease"[tiab] OR SES[tiab] OR poor[tiab] OR poorer[tiab] OR poorest[tiab] OR "low income"[tiab] OR low-income[tiab] OR poverty[tiab] OR impoverished[tiab] OR "low resource"[tiab] OR lowresource[tiab] OR rich[tiab] OR richer[tiab] OR richest[tiab] OR wealth[tiab] OR wealthy[tiab] OR wealthier[tiab] OR wealthiest[tiab] OR uninsured[tiab] OR insured[tiab] OR "social class"[tiab] OR Education[tiab] OR educations[tiab] OR educational[tiab] OR educationally[tiab] OR 3720437 educated[tiab] OR educates[tiab] OR educate[tiab] OR educating[tiab] OR instruction[tiab] OR instructions[tiab] OR instructional[tiab] OR instructionally[tiab] OR instructed[tiab] OR instruct[tiab] OR instructs[tiab] OR instructing[tiab] OR training[tiab] OR trainings[tiab] OR trained[tiab] OR train[tiab] OR trains[tiab] OR trainer[tiab] OR trainers[tiab] OR teaching[tiab] OR teachings[tiab] OR taught[tiab] OR teach[tiab] OR teaches[tiab] OR literacy[tiab] OR literacies[tiab] OR literate[tiab] OR illiterate[tiab] OR illiteracy[tiab] OR illiteracies[tiab] OR "early intervention"[tiab] OR "Head Start"[tiab] OR sociodemographic[tiab] OR sociodemographics[tiab] OR demographic[tiab] OR demographics[tiab] OR ESL[tiab] OR "non-native speaker"[tiab] OR "non-native speakers"[tiab] OR "Language barrier"[tiab] OR "Language barriers"[tiab] OR graduate[tiab] OR "high school"[tiab] OR graduates[tiab] OR diploma[tiab] OR diplomas[tiab]

3720437

5

study

"Follow-Up Studies"[Mesh] OR "Retrospective Studies"[Mesh] OR "Cohort Studies"[Mesh] OR Retrospective[tiab] OR cohort[tiab] OR Multivariate[tiab] OR logistic[tiab] OR regression[tiab]

2920430

1 AND 2 AND 3 AND 4 AND 5

1451

w/ death dying

1887

24142498[uid] OR 27836287[uid] OR

16565899[uid] OR 22566422[uid] OR

21414631[uid] OR 25033158[uid] OR

19412565[uid]

 

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Sooy-Mossey, M., Matsuura, M., Ezekian, J.E. et al. The Association of Race and Ethnicity with Mortality in Pediatric Patients with Congenital Heart Disease: a Systematic Review. J. Racial and Ethnic Health Disparities 11, 2182–2196 (2024). https://doi.org/10.1007/s40615-023-01687-2

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