Cox regression analysis controlling for disease severity, socioeconomic status, and institutional covariates including hospital volume showed that white CDH patients had comparable outcomes regardless of institutional diversity level.
BOB in Ped Surg 2023 - AAP Winner - Shelby Sferra, MD
▶Ep 18 · 3:26
quoteHealth disparities driven by race and ethnicity are pervasive in healthcare and are known to impact all aspects of pediatric care.↗
▶Ep 18 · 3:26
epidemiologicalHealth disparities driven by race and ethnicity are pervasive in healthcare and impact all aspects of pediatric care↗
▶Ep 18 · 3:40
clinicalIn CDH, disparities affect care from prenatal diagnosis and surveillance through postnatal management↗
▶Ep 18 · 4:30
epidemiologicalThe study cohort included 1,625 CDH patients from PHIS database 2015-2020↗
▶Ep 18 · 4:50
clinicalHospital volume was defined as less than 10 CDH cases per year as low volume and 10 or more cases as high volume↗
▶Ep 18 · 5:05
clinicalInstitutional racial and ethnic diversity was defined as the percentage of black and/or Hispanic CDH patients treated at each institution, stratified from less than 20% to greater than 40%↗
▶Ep 18 · 5:40
epidemiologicalHousehold incomes of black and Hispanic patients were significantly lower than that for white patients↗
▶Ep 18 · 5:50
epidemiologicalWhite and Asian patients had primarily commercial insurance, whereas black and Hispanic patients had largely Medicaid payer status↗
▶Ep 18 · 6:10
clinicalBlack patients were born at significantly lower gestational ages and were more likely to be born preterm↗
▶Ep 18 · 6:20
clinicalBlack CDH patients had lower birth weights and lower Apgar scores compared to white patients↗
▶Ep 18 · 6:30
clinicalBlack patients were cannulated to extracorporeal life support more often than white patients↗
▶Ep 18 · 6:40
clinicalBlack CDH patients were mechanically ventilated for longer and required pulmonary anti-hypertensives for longer↗
▶Ep 18 · 6:50
clinicalThese differences in disease severity were not seen in Hispanic and Asian patients when compared to white patients↗
▶Ep 18 · 7:05
clinicalBlack CDH patients were admitted for significantly longer, discharged home less often, and were more likely to require a tracheostomy at discharge↗
▶Ep 18 · 7:20
epidemiologicalBlack patients had decreased in-hospital survival rates of 79% compared to 88% in white patients↗
▶Ep 18 · 7:30
epidemiologicalHispanic and Asian CDH patients had comparable survival rates to white patients at 88% and 92% respectively↗
▶Ep 18 · 7:45
epidemiologicalLow institutional diversity levels (less than 20% minority patients) were associated with decreased survival in white, black, and Hispanic CDH patients↗
▶Ep 18 · 8:00
epidemiologicalHigher levels of institutional diversity (between 31 and 40% minority patients) were associated with improved survival for white, black, and Hispanic CDH patients↗
▶Ep 18 · 8:15
epidemiologicalDifferences in survival based on institutional diversity were not observed in Asian patients↗
▶Ep 18 · 8:22
epidemiologicalCox regression analysis controlling for severity, socioeconomic status, and institutional covariants showed white patients had comparable outcomes regardless of institutional diversity↗
▶Ep 18 · 8:40
epidemiologicalInstitutions with greater than 30% diversity conferred a protective effect against mortality for black CDH patients treated there↗
▶Ep 18 · 8:55
epidemiologicalInstitutions with diversity greater than 20% conferred a protective effect for Hispanic CDH patients↗
▶Ep 18 · 9:05
clinicalTreating a more racially and ethnically diverse patient population improves outcomes for black and Hispanic CDH patients without negatively impacting white patients↗
▶Ep 18 · 9:05
quoteWe demonstrate that treating a more racially and ethnically diverse patient population improves outcomes for black as well as Hispanic CDH patients without negatively impacting white patients.↗
▶Ep 18 · 9:50
quoteI think that there needs to be more initiatives to bring more minority providers into the health care system and I think that that at least the data has shown has improved outcomes and improved survival in many um cases um and in CDH also↗
▶Ep 18 · 10:15
quoteI think that we talk about these disparities, um, and maybe you get one course in medical school on, um, treating racial and ethnic diverse patient populations, but I think that this needs to be something that started in medical school and then continues on in medical education and residency fellowship, um, and even at the attending level as well.↗
BOB Ped Surg 2023 - Shelby Sferra, AAP - Presentation
▶Ep 21 · 0:10
epidemiologicalHealth disparities driven by race and ethnicity are pervasive in healthcare and impact all aspects of pediatric care.↗
▶Ep 21 · 0:10
quoteHealth disparities driven by race and ethnicity are pervasive in healthcare and are known to impact all aspects of pediatric care.↗
▶Ep 21 · 0:30
epidemiologicalIn congenital diaphragmatic hernia (CDH), racial and ethnic disparities affect care from prenatal diagnosis and surveillance through postnatal management.↗
▶Ep 21 · 1:30
clinicalThe study cohort included 1,625 CDH patients from the FIS database (2015-2020) admitted on day of life zero with ICD diagnosis code for CDH and procedure code for repair.↗
▶Ep 21 · 2:00
clinicalHospital volume was defined as less than 10 CDH cases per year (low volume) and 10 or more cases per year (high volume).↗
▶Ep 21 · 2:15
clinicalInstitutional racial and ethnic diversity was defined as the percentage of Black and/or Hispanic CDH patients treated at each institution, stratified into levels from less than 20% to greater than 40%.↗
▶Ep 21 · 2:30
epidemiologicalHousehold incomes of Black and Hispanic CDH patients were significantly lower than that for white patients.↗
▶Ep 21 · 2:40
epidemiologicalWhite and Asian CDH patients had primarily commercial insurance, whereas Black and Hispanic patients had largely Medicaid payer status.↗
▶Ep 21 · 2:50
clinicalBlack CDH patients were born at significantly lower gestational ages and were more likely to be born preterm compared to white patients.↗
▶Ep 21 · 3:00
clinicalBlack CDH patients had lower birth weights and lower Apgar scores compared to white patients.↗
▶Ep 21 · 3:05
clinicalBlack CDH patients were cannulated to extracorporeal life support (ECMO) more often than white patients.↗
▶Ep 21 · 3:12
clinicalBlack CDH patients were mechanically ventilated for longer and required pulmonary anti-hypertensives for longer compared to white patients.↗
▶Ep 21 · 3:20
clinicalDisease severity differences observed in Black CDH patients were not seen in Hispanic and Asian patients when compared to white patients.↗
▶Ep 21 · 3:30
clinicalBlack CDH patients were admitted for significantly longer hospital stays compared to white patients.↗
▶Ep 21 · 3:35
clinicalBlack CDH patients were discharged home less often than white patients.↗
▶Ep 21 · 3:40
clinicalBlack CDH patients were more likely to require a tracheostomy at the time of discharge compared to white patients.↗
▶Ep 21 · 3:45
clinicalBlack CDH patients had decreased in-hospital survival rates of 79% compared to 88% in white patients.↗
▶Ep 21 · 3:45
quoteBlack patients had decreased in hospitals survival rates of 79% compared to 88% in white patients.↗
▶Ep 21 · 3:52
clinicalHispanic and Asian CDH patients had comparable survival rates to white patients at 88% and 92% respectively.↗
▶Ep 21 · 4:00
clinicalLow institutional diversity levels (less than 20% Black and/or Hispanic patients) were associated with decreased survival in white, Black, and Hispanic CDH patients.↗
▶Ep 21 · 4:15
clinicalHigher institutional diversity levels (31-40% Black and/or Hispanic patients) were associated with improved survival for white, Black, and Hispanic CDH patients.↗
▶Ep 21 · 4:25
clinicalInstitutional diversity effects on survival were not observed in Asian CDH patients.↗
▶Ep 21 · 4:30
clinicalCox regression analysis controlling for disease severity, socioeconomic status, and institutional covariates including hospital volume showed that white CDH patients had comparable outcomes regardless of institutional diversity level.↗
▶Ep 21 · 4:40
clinicalInstitutions with greater than 30% racial/ethnic diversity conferred a protective effect against mortality for Black CDH patients treated there.↗
▶Ep 21 · 4:48
clinicalInstitutions with diversity greater than 20% conferred a protective effect against mortality for Hispanic CDH patients treated there.↗
▶Ep 21 · 4:55
clinicalTreating a more racially and ethnically diverse CDH patient population improves outcomes for Black and Hispanic patients without negatively impacting white patients.↗
▶Ep 21 · 4:55
quoteWe demonstrate that treating a more racially and ethnically diverse patient population improves outcomes for black as well as Hispanic CDH patients without negatively impacting white patients.↗
Summaries Shelby gave as host
· 6 summaries
Recaps of other experts' statements, not Shelby's own clinical position.
Summaries Shelby gave as host · Congenital Diaphragmatic Hernia6 summaries
BOB in Ped Surg 2023 - AAP Winner - Shelby Sferra, MD
▶Ep 18 · 3:50
host summaryShelby Sferra summarizing the discussion: Existing studies on disparities in CDH show that black race is an independent risk factor for mortality and is further compounded by low socioeconomic status.↗
▶Ep 18 · 3:50
host summaryShelby Sferra summarizing the discussion: Existing studies show that black race is an independent risk factor for mortality in CDH and is further compounded by low socioeconomic status↗
▶Ep 18 · 9:50
host summaryShelby Sferra summarizing the discussion: Studies show that patient-physician concordance in race and ethnicity improves outcomes for minority patient populations↗
▶Ep 18 · 10:05
host summaryShelby Sferra summarizing the discussion: Patient-physician concordance has been shown to improve outcomes and survival in CDH cases↗
BOB Ped Surg 2023 - Shelby Sferra, AAP - Presentation
▶Ep 21 · 0:45
host summaryShelby Sferra summarizing a resource: Existing studies on disparities in CDH show that Black race is an independent risk factor for mortality and is further compounded by low socioeconomic status.↗
▶Ep 21 · 0:45
host summaryShelby Sferra summarizing a resource: Existing studies on disparities in CDH show that black race is an independent risk factor for mortality and is further compounded by low socioeconomic status.↗
