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By Linda Carroll
(Reuters Health) – A study in California suggests that Hispanic children with certain heart defects have worse than average results. This disparity could be related to the fact that their family depends on public health insurance and the low level of education of mothers.
The lack of education of the mother and her dependence on public insurance can, in turn, be simply markers of other factors, such as poverty, that really explain why white babies and Hispanics behave differently, note the researchers in the Journal of the American Heart Association.
"Factors such as maternal education level and insurance status probably serve as a substitute for other socio-economic factors that hinder access to care and resources. some communities, "said Dr. Shabnam Peyvandi, senior author of the University of California at San Francisco.
The researchers focused on two major congenital cardiac malformations: Hypoplastic Left Heart Syndrome (HLHS) and Large Artery Transposition (TGA). For both, newborns require surgery to correct the problem.
In HLHS, the left side of the heart did not develop properly, which leads to a small left ventricle and aorta. In TGA, two of the main arteries are transposed, each connected to the wrong side of the heart.
As with previous studies, new research found that Hispanic children had more deaths at one year and more readmissions to hospital compared to white children with the same defects.
Peyvandi and his colleagues analyzed data from the California Office of Planning and Health Development regarding more than 3.1 million live births between 2007 and 2012.
Researchers identified 1,796 babies with one of two defects. Of these, 46.7% were Hispanic and 26.6% were white. Peyvandi and his colleagues compared only Hispanic and White babies because other racial and ethnic groups were less well represented.
When researchers examined a range of factors that could affect outcomes, they found that maternal education accounted for 33.2% of the relationship between ethnicity and outcomes, while insurance status accounted for 27 , 6%.
"We could not explain 30% of the disparity, which could be due to factors that we could not measure for this study, such as access to care, income level, etc. . "said Peyvandi in an email. Infant characteristics, such as weight and gestational age at birth, did not contribute to the disparity, she noted.
The findings did not surprise Dr. Gary Satou of the David Geffen School of Medicine at the University of California at Los Angeles and the fetal cardiology program at UCLA Mattel Children's Hospital. .
"These are common things that commonly occur in underserved populations," said Satou, who did not participate in the study. Being Hispanic is not the reason why these kids have worse results, he said. It is the socio-economic factors that can make a huge difference in extremely fragile infants.
Moms without a lot of resources may have to take several buses to get to their baby's appointment. If they have a lower level of education, they may be less able to understand the complicated instructions that are given after the surgery, Satou said. They may also be less likely to recognize signals that something is wrong, whether it is a newly developed eccentric or a change in eating habits.
"There are subtle things that can happen with these babies that have to be detected or it can become a problem in itself or even death," Satou said.
The new study shows that with these babies, "we have to think not only about the quality of the ICU or the surgeon's ability, but also about families returning home, what types of Social support exists, "said Dr. Lisa DeCamp of Johns Hopkins Medicine in Baltimore, who did not participate in the study.
Babies are returning home with complex medical diets, said DeCamp. "They may be under oxygen," she added. "They may need food tubes, which can be more difficult if the mother's health knowledge is weak."
SOURCE: https://bit.ly/2RIVm9B Journal of the American Heart Association, online October 10, 2018.
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