What is the Cumulative Impact of Race & Social Determinants of Health on Minorities’ Single Ventricle Journey Beyond the First Year

Background Race and social determinants of health are known to impact stage-I-palliation (S1P) outcomes. Resources are predominantly focused during their first year of life which may reduce the impact of socioeconomic status (SES) and race. We sought to investigate their impact on long-term outcomes in patients who survived at least one year. Methods The Pediatric-Health-Information-System database was used to identify patients born with Hypoplastic Left Heart Syndrome (HLHS) who underwent S1P and survived to age one. Outcomes and resource utilization were compared by stratifying patients based on SES and race. Results A total of 5,968 children who underwent S1P and survived one year were included. Amongst these, 3,932(66%) were Non-Hispanic White (NHW), 924(15%) were Non-Hispanic Black (NHB) and 569(9%) were Hispanic-Latino (HL). Adjusted one-year conditional mortality demonstrated significantly increased mortality in low-income (LI) Black children (Year 3 LI-Black:7% vs. HI-White:3%, p < 0.001). The difference in mortality ratio was almost double compared to the total unadjusted cohort in year one. In a multivariate analysis for one-year conditional survival at year three, Black children below the poverty line (HR:6.65 [2.06–8.56]p < 0.001) was the strongest predictor of mortality and the HR was lower in unadjusted patients at year one (HR:3.74 [1.89–5.52]p < 0.001). Conclusions Mortality is significantly increased in low-income Black children, and the negative effect of SES is greater after one year. Disparities in HLHS care and social determinants of health become amplified for Black children from low-income families after the first year suggesting that there are opportunities to review resource allocation of vulnerable children.