Abstract 4123478: The Impact of Social Determinants on Growth at 10 Years After the Norwood Procedure: Results from the Single Ventricle Reconstruction (SVR) Trial III

Background: The impact of social determinants of health (SDOH) on growth in patients with hypoplastic left heart syndrome (HLHS) is understudied. In a secondary analysis of the Pediatric Heart Network SVR III study, we explored the impact of SDOH on longitudinal somatic growth through age 10 years in transplant-free survivors with HLHS. Methods: Z-scores adjusted for age for weight (WAZ), height (HAZ), and BMI (BMIZ) were categorized at age 10 years. To assess relationships between z-scores at 10 years and SDOH variables, we modeled all annual measurements for each z-score outcome using a multivariable mixed effects regression that included an interaction between the SDOH predictor and age. We included Hollingshead Score (HH) as a SDOH marker. A higher HH indicates better family socioeconomic status. Results: Of 555 subjects enrolled in the SVR trial, 191 had 10-year growth data. The mean WAZ and HAZ were below normal, with values of -0.3±1.3 (p<0.001) and -0.8±1.2 (p=0.002), respectively. BMIZ did not differ from normal, with a mean value of 0.0±1.3 (p=0.87). WAZ and HAZ were <-2 in 9% and 13%, respectively; BMIZ was <-2 in 4% and >2 in 5%. At birth [coefficient (95% CI)], only higher HH was associated with higher HAZ [0.01 (0.01,0.03), p=0.02]. On multivariable analysis, lower WAZ at 10 years was associated with higher HH [-0.02 (-0.03,0.01)], private insurance [-0.5 (-0.85,-0.16)], and father with college education [-0.64 (-1.06,-0.22)] (p<0.04 for all). Lower BMIZ was associated with higher HH [-0.01 (-0.03,0)] and private insurance [-0.47 (-0.89,-0.04)] (p<0.05 for all). No SDOH factors were independently associated with HAZ at 10 years. Conclusion: Higher SDOH, indicated by private insurance, higher HH and higher father’s education, was associated with lower WAZ and BMIZ at age 10 years. This may be reflective of the general population as children with lower SDOH are at risk for high BMI. It is reassuring that few were under- and over-weight. Survivor bias of children with higher SDOH may also be influencing these results; however, these findings deserve further exploration.