Social Drivers of Health, Management Bias, and Outcomes of Symptomatic Neonates With Tetralogy of Fallot
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Advances in tetralogy of Fallot care have improved outcomes; however, sociodemographic disparities among infants with symptomatic tetralogy of Fallot requiring neonatal intervention (sTOF) remain incompletely characterized. OBJECTIVES: This study aimed to investigate sociodemographic and socioeconomic factors associated with management strategy and clinical outcomes in sTOF. METHODS: We conducted a retrospective cohort study of neonates with sTOF undergoing intervention between January 2005 and November 2017 at 9 centers in the Congenital Cardiac Research Collaborative. The primary outcome was management strategy: primary complete repair vs staged repair. The primary predictor was the Childhood Opportunity Index, a neighborhood-level health composite measure. Secondary predictors included distance to cardiac center, maternal race-ethnicity, language, and insurance. Group differences were assessed using chi-square/Fisher tests with Holm adjustment, and multivariable models determined associations between predictors and outcomes. RESULTS: Among 417 neonates, 180 (43%) underwent primary repair and 237 (57%) staged repair. Most were prenatally diagnosed (59%), non-Hispanic White (63%), and publicly insured (54%). In univariate analyses, Childhood Opportunity Index and maternal race-ethnicity were associated with management strategy; these associations attenuated after adjustment. Infants living >100 miles from a cardiac center had a higher hazard for mortality compared with those <50 miles (HR: 2.38; 95% CI: 1.07-5.30; P = 0.033). Maternal race-ethnicity and public insurance were associated with longer hospital stays and increased in-hospital complications. CONCLUSIONS: Sociodemographic factors, including geography, race-ethnicity, insurance, and neighborhood opportunity, are associated with management and outcomes in neonates with sTOF. Distance to care, maternal race-ethnicity, and insurance have notable impacts on these outcomes and warrant further assessment to ensure equitable decision-making management strategies.
Source: JACC Advances
Authors: Flora Nuñez Gallegos, Shiraz A. Maskatia, Yun Zhang, Jeffrey D. Zampi, George T. Nicholson, Courtney McCracken, Christopher E. Mascio, Christopher J. Petit, Jennifer Romano, Dominic Zanaboni, Michael L. O’Byrne, Alekhya Nanduri, Jeannette Wong-Siegel, Mark A. Law, Courtney R. Alvis, Shabana Shahanavaz, Sarosh P. Batlivala, Sarah Speed, Jeffery J. Meadows, Mariam Taleb, Athar M. Qureshi, Hala Khan, R. Allen Ligon, Rachel Weber, Bryan H. Goldstein, Andrew C. Glatz, Keila N. Lopez
Institutions: University of California, San Francisco, Stanford Medicine, Stanford University, Columbia University, University of Michigan, Vanderbilt University Medical Center, Kaiser Permanente, West Virginia University, Washington University in St. Louis, Children's Hospital of Philadelphia, University of Alabama, University of Alabama at Birmingham, Cincinnati Children's Hospital Medical Center, Texas Children's Hospital, Emory University, Children's Healthcare of Atlanta, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Children's Hospital Colorado
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,936
OpenAlex ID: W7203915119