Racial and insurance disparities in hospital referral and mortality for children undergoing congenital heart surgery

Racial and insurance disparities have been documented in survival following congenital heart surgery. However, many studies used limited state or regional data. This study examines the impact of race and insurance status by applying a comprehensive risk-stratification system to two of the most recent national pediatric hospitalization databases. All admissions that fit a Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) category from the Kids' Inpatient Database (KID) 2003 and 2006 were examined. Patient demographics and hospital characteristics were compared between survivors and nonsurvivors as well as between insurance groups. Logistic regression models examining hospital mortality, referral to high mortality hospitals, and emergent admissions were constructed. Children with Medicaid insurance had increased odds of mortality in 2003 (Odds Ratio 1.6, 95% Confidence Interval 1.2-2.1). In 2006, nonwhite children had higher odds of mortality (Odds Ratio 1.4, 95% Confidence Interval 1.0-2.0). When examining low mortality hospitals in 2006, where greater than 85% of children received care, neither race nor insurance status were independently associated with hospital mortality. However, in both years, children with Medicaid insurance and nonwhite children were more likely to be emergently admitted to hospital for a cardiac surgical procedure. Hospital mortality disparities based on insurance status and race appear to be improving. However, insurance and race continue to play a role in access to timely pediatric cardiac services.