Key result
Remote residence linked to ~23% fewer annual cardiology visits in pediatric congenital heart disease.
Why the study?
Data are limited on how remoteness of residence and socioeconomic status affect access to care and outcomes for children with congenital or acquired heart disease in a jurisdiction with universal health and centralized cardiac care.
Does remoteness of residence and socioeconomic status impact access to care and outcomes for children with heart disease?
Cohort (n=12,542)
Yes
Does remoteness of residence and socioeconomic status impact access to care and outcomes for children with heart disease?
Relative Risk: 0.77 (95% CI 0.67–0.88)
p-value: p=<0.0001
In a universal healthcare system, remoteness of residence and socioeconomic status do not negatively impact clinical outcomes or access to initial intervention for children with heart disease, though they do reduce outpatient cardiology surveillance.
Reduced visits with remoteness did not worsen outcomes in pediatric CHD; leaves open whether surveillance gaps affect long-term prognosis.
There is a paucity of data regarding the impact of remoteness of residence (RoR) and socioeconomic status (SES) on access to care and outcomes for children with congenital heart disease (CHD) or acquired heart disease (AHD) in a jurisdiction of universal health and centralized cardiac care. The primary objective was to examine whether RoR, SES, and their interaction impact access to health care and outcomes for children with heart disease in Alberta, Canada. This was a population-based study of children with CHD or AHD born between January 1, 2005, and December 31, 2017, in Alberta, Canada. Primary outcomes included age at diagnosis, time from diagnosis to intervention, number of annual primary care visits, annual cardiologist visits, annual emergency room visits, and survival. Multivariable Cox proportional hazards models identified independent associations. Longitudinal relationships between the number of annual physician visits and RoR and SES were assessed with multivariable Poisson models. We included 12,542 children (94% CHD, 6% AHD), 70.4% living <60 minutes’ drive of a cardiac center, and 10.9% residing >180 minutes away. RoR and SES were not associated with age at diagnosis, time from diagnosis to intervention, annual primary care visits, or transplant free survival for either CHD or AHD. Although SES demonstrated no impact, annual annual cardiologist visits were inversely related to RoR for CHD (60-180 minutes rate ratio [RR]: 0.83, 95% CI: 0.73-0.95; >180 minutes RR: 0.77, 95% CI: 0.67-0.88; P < 0.0001) and AHD (60-180 minutes RR: 0.63, 95% CI: 0.39-1.00; >180 minutes RR: 0.53, 95% CI: 0.34-0.84; P = 0.02). Additionally, increased annual emergency room visits were associated with further RoR ( P < 0.001) in both CHD and AHD and lower SES ( P < 0.001) only for those with CHD. Age at diagnosis, time to intervention, annual primary care visits, and transplant-free all-cause survival were not impacted by RoR or SES in children with heart disease. Greater RoR and SES, however, were associated with fewer annual cardiology visits and increased annual emergency room visits, which highlights the need for novel surveillance strategies for remote pediatric patients with heart disease.
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Conway et al. (2024) conducted a cohort in Congenital or acquired heart disease (n=12,542). Remoteness of residence vs. Residence <60 minutes drive to pediatric cardiac center was evaluated on Annual cardiologist visits (CHD patients >180 minutes vs <60 minutes from center) (RR 0.77, 95% CI 0.67-0.88, p=<0.0001). Greater remoteness of residence (>180 minutes) was associated with fewer annual cardiology visits compared to living within 60 minutes for children with congenital heart disease (RR 0.77).
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