P2A095: Disparities in Cardiovascular Health Treatment Outcomes in a Pediatric Preventive Cardiology Clinic

Background: Children with dyslipidemia and elevated body mass index (BMI) are at increased risk for atherosclerotic cardiovascular disease, the number one cause of mortality worldwide. Early treatment has been shown to reduce risk of cardiovascular disease in adulthood. Links exist between hierarchies of social advantage and health outcomes, but there is currently no data evaluating health disparities in cardiovascular health outcomes in pediatric populations. The purpose of this study is to evaluate outcomes of treatment in children with acquired dyslipidemia based on socioeconomic status (SES) and rural/urban status.

Methods: Retrospective chart review was conducted of pediatric patients with acquired dyslipidemia that presented to a Midwest pediatric preventive cardiology clinic from 1/1/2010 to 12/31/2022. Subjects with at least two laboratory tests or clinic visits were included. Each subject’s lipid panel, body mass index (BMI), and waist circumference (WC) from dates of their initial and final clinic visits or laboratory tests were abstracted. Patient’s SES and rural/urban status were estimated using zip codes by linking medical records with the National Neighborhood Data Archive and a rural/urban classification system developed by Wisconsin Collaborative for Healthcare Quality. Changes in lipid panel values, BMI, and WC were analyzed by patient SES and rural/urban status using univariate and multivariate linear regression.

Results: A total of n=1556 subjects were identified. The mean percentage of people with less than a high school diploma in areas where our study population resided was 7.0%, while the mean proportion with past 12-month income below poverty level was 10.6%. The majority of patients (76.2%) were from areas classified as urban. Between first and final visit, total cholesterol on average reduced by 22.3 mg/dL (SD=43.6 mg/dL), triglycerides by 29.7 mg/dL (SD=128.2 mg/dL), non-HDL-C by 21.9 mg/dL (SD=42.5 mg/dL), and LDL-C by 16.8 mg/dL (SD=40.3 mg/dL). In contrast, there was no change in mean BMI, and WC increased by 5.0 cm (SD=10.2 cm). By univariate analysis, patients living in areas with lower rates of people with incomes below poverty level or with a lower proportion of people with less than high school diploma had greater decreases in their total cholesterol, non-HDL-C, LDL-C, and WC (p < 0.05, Table 1). Living in urban areas was associated with less decrease in total cholesterol, LDL-C and WC (p < 0.05). After the adjustment of all these factors (i.e. multivariate analysis), rates of people living with incomes below poverty level still predicts overtime changes in total cholesterol and non-HDL-C (p < 0.05).

Conclusion: Disparities in health outcomes by socioeconomic status and rural/urban status are observed in the pediatric preventive cardiology clinic. Public health efforts may be needed to improve cardiometabolic health and reduce health disparities among children with acquired dyslipidemia.