By Linda Carroll
Hispanic infants with certain heart defects have worse-than-average outcomes, and the disparity may be linked with their family’s reliance on public health insurance and lower education levels in moms, a California study suggests
A mother’s lack of education and reliance on public insurance may, in turn, simply be markers for other factors, such as poverty, that really explain why white and Hispanic babies fare differently, the researchers note in the Journal of the American Heart Association.
“Factors such as maternal educational levels and insurance status likely act as a proxy for other socioeconomic factors that impede access to care and resources to certain communities,” said lead author Dr. Shabnam Peyvandi of the University of California, San Francisco.
The researchers focused on two major congenital heart defects: hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA). For both of these, newborns require surgery to correct the problem.
In HLHS, the left side of the heart hasn’t developed properly, leading to a left ventricle and aorta that are too small. In TGA, two of the major arteries are transposed, each connected to the wrong side of the heart.
As with earlier studies, the new research found that Hispanic infants had more deaths at one year and more hospital readmissions compared to white infants with the same defects.
Peyvandi and colleagues analyzed data from the California Office of Statewide Health Planning and Development on more than 3.1 million live births from 2007-2012
The researchers identified 1,796 babies with one of the two defects. Of these, 46.7 percent were Hispanic and 26.6 percent were white. Peyvandi and colleagues compared just the Hispanic and white babies, because other racial and ethnic groups were less well represented.
When the researchers looked at a host of factors that could affect outcomes, they found that maternal education accounted for 33.2 percent of the relationship between ethnicity and outcome, while insurance status explained 27.6 percent.
“We could not explain 30 percent of the disparity, which may be due to factors that we were unable to measure for this study, such as access to care, income level, etc.,” Peyvandi said in an email. Infant characteristics, like weight and gestational age at birth, did not contribute to the disparity, she noted.
The findings didn’t surprise Dr. Gary Satou of the David Geffen School of Medicine at the University of California, Los Angeles and the fetal cardiology program at the UCLA Mattel Children’s Hospital.
“These are common things that happen commonly in under served populations,” said Satou, who wasn’t involved in the study. Being Hispanic isn’t why these children have poorer outcomes, he said. It’s the socioeconomic factors that can make a huge difference in infants who are extremely fragile.
Moms without many resources may have to take multiple buses to get to their babies’ appointments. If they have a lower educational level, they may be less able to understand the complicated sets of instructions that are given after surgery, Satou said.
They may also be less likely to recognize signals that something is going wrong, whether it’s a newly developed crankiness or a change in eating habits
“There are subtle things that can happen with these babies that need to be detected or it can develop into a full-blown problem or even death,” Satou said.
The new study shows that with these babies, “we need to think not only about the quality of the intensive care unit or the ability of the surgeon, but also what families are going home to, what kind of social support structures there are,” said Dr. Lisa DeCamp of Johns Hopkins Medicine in Baltimore, who wasn’t involved in the study.
The babies are going home with complex medical plans, DeCamp said. “They may be on oxygen,” she added. “They may require feeding tubes. That can be more challenging if the mother’s health literacy is low.”
SOURCE: Journal of the American Heart Association, online October 10, 2018
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