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330709
Exploring Health Disparities in Asian and Pacific Islanders in Pediatric Heart Transplantation in the US


Tuesday, November 3, 2015

Lan Doan, MPH, CPH, School of Social and Behavioral Health Sciences, Oregon State University, College of Public Health and Human Sciences, Corvallis, OR
David Rosenthal, MD, Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA
Seth Hollander, MD, Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA
Beth Kaufman, MD, Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA
Daniel Bernstein, MD, Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA
Katsuhide Maeda, MD, Department of Pediatrics (Cardiothoracic Surgery), Stanford University, Palo Alto, CA
Esther Liu, RN, FNP-BC, Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA
Sharon Chen, MD, MPH, Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA
Christopher Almond, MD, MPH, Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA
BACKGROUND:   Pediatric heart transplant (HT) outcomes for the largest racial/ethnic groups have been well described, but little is known about outcomes for Asian and Pacific Islanders (API).   We sought to characterize HT outcomes of API children to determine if their historical survival trends are more similar to whites or underrepresented minorities (blacks/Hispanics). 

METHODS:    Patients ≤25 years of age listed for isolated HT since 1986 were identified using OPTN data.  Race/ethnicity was analyzed as reported by centers.  Survival was estimated using the Kaplan-Meier method.  Waitlist mortality was defined as waitlist removal due to death or clinical deterioration.

RESULTS:   Of 15,686 patients listed for HT, 517 (3.3%) were API, including 458 (2.9%) Asian and 59 (0.4%) Pacific Islander (PI) patients.  API patients were more similar to whites at transplant listing than blacks/Hispanics, although APIs were more likely to have blood type B and normal renal function than non-API patients. Overall, API and non-API patients had similar unadjusted waitlist mortality.  Of 10,181 patients transplanted, 368 (3.6%) were API, including 329 (3.2%) Asian and 39 (0.4%) PI patients. Overall post-transplant survival was similar for API and non-API patients, however, Asians had a trend toward longer survival (similar to whites) compared to PIs (similar to blacks/Hispanics).

CONCLUSION:   Overall waitlist and post-heart transplant survival for API pediatric patients is similar to other racial/ethnic groups, however, PIs have a trend toward shorter post-transplant survival compared to Asians.  Further research is warranted to understand racial/ethnic disparities in post-transplant survival for Asians and Pacific Islanders.

Learning Areas:

Clinical medicine applied in public health
Epidemiology

Learning Objectives:
Describe waitlist and post- heart transplantation outcomes for Asian and Pacific Islander pediatric patients. Compare waitlist and post-heart transplantation outcomes for Asian and Pacific Islanders versus other racial/ethnic groups.

Keyword(s): Health Disparities/Inequities, Asian and Pacific Islanders

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the clinical research coordinator for the investigator-initiated and industry-sponsored studies in the Department of Pediatric Cardiology at Lucile Packard Children’s Hospital- Stanford University. I have a MPH, with a focus in Community Health and Education, and have over five years of research experience. My public health research interests include health disparities and inequities among underserved populations and community-based participatory research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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