Intersection of paediatric heart disease and foster care status: a multicentre retrospective cohort study

BACKGROUND: Children and youth in foster care (CYFC) face unique medical, social and economic challenges that contribute to health disparities. CYFC with heart disease represent a particularly high-risk population, yet their characteristics and outcomes are underexplored. METHODS: In this multicentre, retrospective cohort study of all cardiac surgical and non-surgical heart disease admissions among children <18 years between 2017 and 2022, CYFC were identified using the International Classification of Disease, Tenth Revision (ICD-10) code Z62.21 in the Pediatric Health Information System database. Demographics, clinical characteristics and outcomes of CYFC were compared with those of children not in foster care (non-CYFC). Multivariable models assessed associations between foster care status and length of stay (LOS), in-hospital mortality and 30-day readmissions, adjusting for a fixed set of clinical variables. Childhood Opportunity Index, race and region were added separately to assess the influence of social determinants of health. RESULTS: Of 95 113 total cardiac surgical and non-surgical admissions, 627 (0.7%) were identified as CYFC. CYFC were significantly more likely to have ≥2 complex chronic conditions, be Black and non-Hispanic, have public insurance, reside in rural locations and have lower Childhood Opportunity Index scores. After adjustment for clinical variables, LOS was 22% longer (95% CI 8% to 36%, p=0.001) for CYFC. There were no significant differences in in-hospital mortality or 30-day readmissions. These findings were unchanged after incorporation of Childhood Opportunity Index, race and region. CONCLUSIONS: CYFC with heart disease experience greater medical complexity and have significantly longer hospital stays than their peers, despite similar in-hospital mortality and 30-day readmission rates. These findings highlight foster care status as an important and often under-recognised social determinant of health in paediatric cardiology and provide a foundation for future work to better understand and address factors influencing outcomes in this population.