BOB Ped Surg 2023 - Shelby Sferra, AAP - Presentation

Health disparities driven by race and ethnicity are pervasive in healthcare and impact all aspects of pediatric care.

In congenital diaphragmatic hernia (CDH), racial and ethnic disparities affect care from prenatal diagnosis and surveillance through postnatal management.

The study cohort included 1,625 CDH patients from the FIS database (2015-2020) admitted on day of life zero with ICD diagnosis code for CDH and procedure code for repair.

Hospital volume was defined as less than 10 CDH cases per year (low volume) and 10 or more cases per year (high volume).

Institutional racial and ethnic diversity was defined as the percentage of Black and/or Hispanic CDH patients treated at each institution, stratified into levels from less than 20% to greater than 40%.

Household incomes of Black and Hispanic CDH patients were significantly lower than that for white patients.

White and Asian CDH patients had primarily commercial insurance, whereas Black and Hispanic patients had largely Medicaid payer status.

Black CDH patients were born at significantly lower gestational ages and were more likely to be born preterm compared to white patients.

Black CDH patients had lower birth weights and lower Apgar scores compared to white patients.

Black CDH patients were cannulated to extracorporeal life support (ECMO) more often than white patients.

Black CDH patients were mechanically ventilated for longer and required pulmonary anti-hypertensives for longer compared to white patients.

Disease severity differences observed in Black CDH patients were not seen in Hispanic and Asian patients when compared to white patients.

Black CDH patients were admitted for significantly longer hospital stays compared to white patients.

Black CDH patients were discharged home less often than white patients.

Black CDH patients were more likely to require a tracheostomy at the time of discharge compared to white patients.

Black CDH patients had decreased in-hospital survival rates of 79% compared to 88% in white patients.

Hispanic and Asian CDH patients had comparable survival rates to white patients at 88% and 92% respectively.

Low institutional diversity levels (less than 20% Black and/or Hispanic patients) were associated with decreased survival in white, Black, and Hispanic CDH patients.

Higher institutional diversity levels (31-40% Black and/or Hispanic patients) were associated with improved survival for white, Black, and Hispanic CDH patients.

Institutional diversity effects on survival were not observed in Asian CDH patients.

Cox regression analysis controlling for disease severity, socioeconomic status, and institutional covariates including hospital volume showed that white CDH patients had comparable outcomes regardless of institutional diversity level.

Institutions with greater than 30% racial/ethnic diversity conferred a protective effect against mortality for Black CDH patients treated there.

Institutions with diversity greater than 20% conferred a protective effect against mortality for Hispanic CDH patients treated there.

Treating a more racially and ethnically diverse CDH patient population improves outcomes for Black and Hispanic patients without negatively impacting white patients.