P2A097: Cardiovascular Health in Children with Chronic Conditions

Background: A quarter of children in the United States have at least one chronic condition. Researchers have previously shown that children with chronic conditions have worse general health compared to their peers without a chronic condition. However, there is little information about cardiovascular health (CVH) among children with chronic conditions.

Methods: We utilized electronic health record data from the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN), which included four non-profit hospital systems and one public hospital, from 2010 to 2018. We identified children aged two through 12 who attended at least one ambulatory visit and had an ICD diagnosis or treatment code for one of six chronic conditions: asthma, cerebral palsy (CP), cystic fibrosis (CF), congenital heart disease (CHD), epilepsy, and sickle cell anemia. We also identified children who had no reported chronic conditions using the Pediatric Complex Chronic Conditions classification system (Version 2). We calculated CVH using the four clinical components of the American Heart Association Life’s Simple 7 (body mass index, blood pressure, total cholesterol, and blood glucose) for all children at each year of age available. Missing component values were singly imputed. Each component was scored as 0 for poor, 1 for intermediate, and 2 for ideal. The four components were summed to create a composite clinical CVH measure with a maximum of 8 points. We calculated the mean (standard deviation) clinical CVH overall and by age category (2-5, 6-9, and 10-12 years) for each chronic condition. Finally, we compared CVH among those with a chronic condition to those without any chronic conditions.

Results: We identified 6,829 children (or 17,467 child-years) with a chronic condition in CAPriCORN. Overall clinical CVH ranged from 7.03 for children with cystic fibrosis to 6.71 for children with epilepsy. Children with asthma and epilepsy had lower clinical CVH than their peers without a chronic condition overall and at all age categories (p <.0001). Children with CP had lower CVH than healthy peers from ages 2-5 and 6-9 years (p = 0.0013 and p <.0001, respectively) but did not differ from their peers from ages 10-12 years. Whereas children with CF did not differ from healthy peers from ages 2-5 and 6-9 years but had higher CVH than their peers from ages 10-12 (p = 0.0131).

Conclusion: We found that clinical CVH in children with chronic conditions varied by condition and age. CVH in children with and without a chronic condition is less than ideal; however, children with, asthma and epilepsy had lower CVH than their peers without a chronic condition throughout childhood highlighting the need for multidisciplinary health care among children with chronic conditions.