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A UCLA study on children born with heart disease showed that when comparing the child's age at surgical repair, children with private insurance underwent surgery at a younger age than children with managed care health plans. Children with managed care health plans had their surgery at a younger age than children with Medi-Cal. Additionally, Asian children tended to be older at the time of surgical repair of congenital heart defects.
"This study suggests that type of insurance and race have strong influences on the utilization of health services in children with heart disease," said lead author Dr. Ruey-Kang R. Chang, a UCLA pediatric cardiologist at the Mattel Children's Hospital at UCLA. The UCLA study was published in the May issue of the journal Pediatrics.
UCLA researchers studied the age at which complete surgical repair was performed for the four most common types of heart problems in children - atrial septal defect, ventricular septal defect, tetralogy of Fallot and atrioventricular canal defect. The study used hospital discharge data from California in the years 1995 and 1996. The researchers examined many factors, such as gender, race, type of insurance, surgical centers, and urban or rural home location that might influence age at repair for heart disease in children.
"Because congenital heart diseases are present at birth, the age at which surgical repair is performed on a child is a good indicator for access to and utilization of needed health care services for children," said UCLA pediatrician Dr. Alex Y. Chen, the study's co-author.
Previous studies have shown that children born with heart disease who live in non-urban areas or do not have private insurance are at risk for delayed referral to a pediatric cardiologist. However, the effect of these factors on the age at which cardiac surgery is performed had not been evaluated. Researchers designed the UCLA study to evaluate the factors that influence the age when children receive definitive surgical repair.
In the two years of all hospital discharges in California studied, 666 children underwent atrial septal closure (average age 5.1 years), 582 ventricular septal closure (average age 2.8), 394 tetralogy of Fallot repair (average age 1.7) and 177 atrioventricular canal defect (average age 1.1).
Comparing median and mean age at surgery, the UCLA researchers found a consistent trend for all four types of CHD, indicating that for median age at operation, children were younger by 6 months to one year if they had private insurance versus managed care. Children covered by managed care plans received surgical intervention at a slightly younger age than those covered by Medi-Cal. Gender had no effect on age at operation. Although the researchers did not find statistical difference in age at repair among various ethnic groups, Asians tended to be older at surgery for all four types of CHD.
Researchers also found that surgical centers performing more surgeries tended to operate on children at younger age. In addition, children who lived in urban areas tended to be older at time of surgical repair. No significant correlation was found between distance to surgical center and age at operation.
"Many medical and non-medical variables play important roles in determining age for definitive repair of congenital heart disease in children," said UCLA's Chief of Pediatric Cardiology Thomas S. Klitzner, M.D., Ph.D., and a senior co-author of the study. "Type of insurance, a recognized surrogate for access to care, may play an important role. In addition, our analysis showed that centers with higher surgical case volume were more likely to operate at a younger age and children in urban areas tended to be older at the time of surgery."
The UCLA researchers are all members of the Mattel Children's Hospital at UCLA. The Mattel Children's Hospital at UCLA offers a full spectrum of primary and specialized medical care for infants, children and adolescents, providing state-of-the-art treatment for children in a compassionate atmosphere, as well as conducting research that improves the understanding and treatment of pediatric diseases.
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