Abstract
Background
Low family socioeconomic status is a known factor that can contribute to increased mortality for patients with cardiovascular disease. However, in developing countries, the prognostic impact of socioeconomic level on pediatric HTx is unclear, particularly in developing countries.
Methods
We conducted a retrospective cohort analysis of children younger than 18 years who underwent heart transplantation (HTx) at our center from October 1, 2005, to May 31, 2023. To assess the impact of socioeconomic status, we followed up with the discharged children until September 30, 2023, monitoring for all-cause mortality and unplanned readmission events. To evaluate the relationship between socioeconomic status and prognosis, we assigned a composite score based on an assessment of household income, parental education level, and occupation. The Cox proportional hazards model and the Kaplan-Meier method were utilized for this analysis.
Results
64 children (median age at operation 14 years, IQR 13–15) were enrolled and one case died in hospital due to HF, 63 (98.4%) children had a median follow-up of 60 months (IQR 5.9-113.9). During the follow-up period, 10 (15.9%) children died, and 20 (31.7%) children had 25 unplanned readmissions. Children had higher all-cause mortality and more unplanned readmissions in families with low socioeconomic status (n = 33) than middle (n = 10) or high (n = 20) family socioeconomic status. Hazard ratios were 5.99,(95%CI:2.28–10.64, P = 0.003) for all-cause mortality for low versus high family socioeconomic status, and 2.53 (95%CI:1.04–9.43, P = 0.029) for middle versus high family socioeconomic status.
Conclusions
Lower family socioeconomic status is associated with a worse prognosis than high family socioeconomic status. Measures to alleviate economic disparities are needed to improve the prognosis of pediatric HTx.