1349393 - Association of sociodemographic and geographic factors with diagnostic utilization and clinical imaging findings in repaired Tetralogy of Fallot

Children with repaired Tetralogy of Fallot (rTOF) patients benefit from surveillance with cardiac magnetic resonance (CMR) imaging to identify cardiac dysfunction needing surgery.  Socioeconomic (SES) and geographic factors barriers may prevent timely receipt of CMR; this effect in rTOF patients has not been studied. We studied the association of SES and race/ethnicity on access to CMR utilization and biventricular function in a retrospective cohort of rTOF patients.  



Methods:

rTOF patients >2 years of age referred for CMR from 2010-2021 were compared against concurrent surgical cohort of rTOF patients < 2 years of age. The surgical cohort served as control, representing patients receiving standard short-term care. Self-reported race, ethnicity and addresses were collected. Census tract software cdxzipstream extracted census tract characteristics and a composite SES score was derived, using 6 variables representing wealth, income, education, and occupation. Measurements of function including left ventricular ejection fraction (LVEF) within the CMR cohort were also collected.  



Results:

383 patients were identified in the CMR cohort and 239 patients in the surgical cohort. There were significant differences in SES and demographic, but no significant differences in anatomical subtype  (Table 1). The CMR cohort lived in areas with less poverty (p < 0.001), higher median income (p < 0.001) and higher composite SES score (p < 0.001). The CMR cohort had more white patients and more non-Hispanic patients (p < 0.001, p=0.005). The CMR cohort had a greater proportion of patients with private insurance, compared to patients in the control cohort, who had mostly public insurance (p < 0.001). Within the CMR cohort, patients with left ventricular dysfunction (defined as LVEF < 55%) lived in areas with more poverty (p = 0.043), lower median income (p=0.008) and lower composite SES score (p = 0.005).



Conclusion:

CMR utilization and metrics of cardiac function may have SES and racial/ethnic disparities in rTOF patients.  The results have implications in healthcare equity and long-term outcomes for this growing population of patients. Further study is needed to identify the underlying mechanisms and the role of race.