P2A163: Racial and Socioeconomic Variability in Advanced Cardiac Imaging & 3D Printing

Background: 3D models of patient-specific anatomy derived from advanced imaging are becoming essential for the care of patients with complex congenital heart disease. Given known disparities in healthcare, it is critical to investigate whether these advanced techniques are utilized differently across different racial and socioeconomic groups.

Methods: Chart review was conducted for all patients who had a 3D cardiac model created, a total of 149 prints, from the inception of clinical 3D printing in August 2017 at Duke University Hospital System (DUHS) through October 2022. Demographic information (sex, race, age, and zip code), cardiac diagnoses, imaging modality, 3D model type, inpatient or outpatient status at time of imaging, interventions, and ordering indication were recorded. Demographic data were compared to State, County, and institutional Pediatric Interventional Cardiology and Congenital Cardiothoracic Surgical databases to investigate for discrepancies between the population referred for 3D printing and the population expected to be admitted to DUHS.

Results: 3D cardiac printing is being performed at higher rates than expected in patients considered to be in a racial minority.  A slight majority (40%) of total prints were performed in patients identified as Caucasian/White, but this is lower overall than that population of North Carolina (60%) and DUHS’s Interventional Cardiology and Congenital Cardiac Surgical populations (61% and 53% White, respectively). A higher percentage of prints are being performed in patients identified as Black (32%) than the population of North Carolina (22%) and DUHS’s interventional cardiology and congenital cardiac surgical populations (26% and 29% Black, respectively). Patient zip code data showed that while the majority of 3D print patients are from the capital county, Wake County, the majority of prints (65%) come from counties that are classified as more economically depressed by the N.C. Department of Commerce. Zip code results were similar to the relative distribution of DUHS congenital cardiac surgical patients.

Conclusion: This initial review suggests that advanced cardiac imaging and 3D printing resources are not under-performed, but rather over-performed in racial minority and/or low socioeconomic groups in DUHS’s pediatric and congenital heart population. Additional investigation is needed to determine if this is inequitable care and the causes of the differences in utilization beyond those expected by population demographics.