Outcome Disparities Between Rural and Urban Infants with Single-Ventricle Heart Disease.

Abstract

To evaluate the impact of home location in an urban or rural environment on somatic growth and transplant-free survival in infants with single-ventricle heart disease at 1 year of age. Data were reviewed from 67 centers using the National Pediatric Cardiology-Quality Improvement Collaborative database between 2016 and 2020. Urban or rural home location was determined using the home ZIP code's rural-urban commuting area code. One-year weight and height z scores and 1-year transplant-free survival were compared between urban and rural groups. Analysis was performed both unadjusted and with adjustments for covariates. Subgroup analysis was performed for race and ethnicity, sex, and insurance type. Multiple imputation was performed to account for missing data in outcomes analysis. Data from 1403 urban and 351 rural patients were analyzed. Urban infants had greater weight (-0.95 vs -1.16, P < .01) and height z scores (-1.65 vs -2.01, P < .01) at 1 year of age when compared with rural infants. When adjustments were made for covariates, there was no significant difference (weight P = .21, height P = .15). Odds of 1-year transplant free survival were lower in urban compared with rural infants (odds ratio for urban vs rural 0.72, P < .02). Rural infants with single-ventricle heart disease have greater transplant-free survival to their first birthday. Growth among rural infants may lag behind urban peers, but growth differences are attributable to demographic and disease severity factors.