Abstract 4146742: <i>Outstanding Research Award in Pediatric Cardiology:</i> Association of rurality with long-term survival after congenital heart surgery

Objective: Disparities in health outcomes exist between metro and non-metro areas for many medical conditions, but this issue has not been examined within the context of congenital heart disease (CHD). This study aims to determine the association of metro vs. non-metro residence status with long-term survival after congenital heart surgery (CHS). Methods: This retrospective cohort study included patients from the Pediatric Cardiac Care Consortium who had initial CHS between 1990 and 2003. Outcomes were tracked using the National Death Index through 2022. Analysis was restricted to counties where PCCC patients resided. Based on the description of Rural-Urban Continuum Codes (RUCCs), we categorized counties in metro and non-metro areas per the 1993 and 2003 RUCCs, including two subgroups (adjacent to a metro area and not adjacent to a metro area). Kaplan-Meier survival estimates were plotted to compare long-term survival in patients living in metro vs non-metro areas. Comparison of survival length between areas was performed by fitting semiparametric accelerated failure time models with adjustment for covariates. Results: Among 28,504 patients (47.0% female), 19,772 (69.4%) resided in metro areas. Patients living in non-metro areas experienced an absolute lower 30-year survival following discharge post initial CHS vs. patients living in metro areas (86.5 vs. 88.4%, log-rank p=0.015) (Figure) with a 22% reduction in median survival time [adjusted time ratio (aTR): 0.78; 95%CI 0.64-0.94] after adjustment for sex, birth era, CHD severity, and chromosomal abnormality. Additional adjustment for neighborhood socioeconomic status (nSES) attenuated the association’s magnitude (aTR: 0.91; 95% CI: 0.74-1.13). Subgroup analysis indicated that decreased survival time was significant only for those living in non-metro and not adjacent to metro areas (aTR: 0.73; 95% CI: 0.57-0.93). Conclusion: In this large multicenter study, non-metro residency, particularly in areas not adjacent to metro areas, was associated with reduced median survival time, an attenuated effect explained by nSES differences. Targeted interventions are needed to reduce disparities and improve outcomes post-CHS.