JACC Adv. 2026 May;5(5):102773. doi: 10.1016/j.jacadv.2026.102773.
ABSTRACT
BACKGROUND: Social determinants of health (SDoH) in pediatric pulmonary hypertension (PH) outcomes are inadequately characterized.
OBJECTIVES: The authors examined associations between SDoH and pediatric PH outcomes.
METHODS: This retrospective cohort study utilizes the Pediatric Health Information System (47 children's hospitals). All pediatric PH patients with encounters from January 1, 2016, to December 31, 2022, were identified using International Classification of Diseases-10 codes. Demographics, therapeutics, and outcomes were compared according to SDoH including Child Opportunity Index (COI 3.0), race/ethnicity, insurance status, urbanicity, and home-to-hospital distance. Associations between SDoH and mortality were modeled, with each SDoH analyzed separately with clinical variables.
RESULTS: Of 24,321 pediatric PH patients, 1,702 (7.0%) died. The median age at first admission was 1 year (IQR: 0, 5) with PH groups of pulmonary arterial hypertension (n = 11,296, 46.4%), left heart disease (n = 2,332, 9.6%), lung disease (9,165, 37.7%), thromboembolic (n = 180, 0.7%), and other (n = 1,348, 5.5%). No difference in the therapy use was observed by COI. Unadjusted mortality differed by COI quintile, with the highest proportion of deaths in very low (8.5%) vs very high (6.1%, P < 0.001). Mortality was higher for patients with public insurance, Black/African American race and those living further from hospital. In multivariable models adjusting for baseline unmodifiable factors and condition severity/therapy use, patients from the very high COI quintile had significantly lower odds of mortality vs very low quintile (adjusted OR: 0.78; 95% CI: 0.67-0.90; P < 0.001).
CONCLUSIONS: In this study of pediatric PH outcomes by SDoH at U.S. children's hospitals, lower COI, Black/African American race, public insurance, and greater home-to-hospital distance were associated with higher mortality.
PMID:42206790 | DOI:10.1016/j.jacadv.2026.102773