Race and Health Outcomes: An Example ​of​ Congenital Heart Disease

A significant body of recent research has focused on inequities in health care outcomes across racial and ethnic lines. These inequities pervade every specialty. In the case of congenital heart disease (CHD), recent medical and surgical advances have improved the lives of affected children, but significant racial and ethnic disparities in outcomes still exist.  

“While the medical and surgical management of children with congenital heart defects ​Click here to enter text.​has continued to advance, research has demonstrated that African​ ​American patients experience worse outcomes in comparison to Caucasian patients​,​” said Deidra Ansah, MD, Pediatric Cardiologist at Texas Children’s Hospital. 

Inequities in CHD outcomes 

Social determinants of health (SDOH) describe how the environment in which a person lives, works and goes to school affects one’s health. “Inequalities at individual, institutional and societal levels result in poorer SDOH and have negatively affected the health of communities of color​.​​Click here to enter text.​​ T​his includes patients with CHD​,​​Click here to enter text.​” said Dr. Ansah.  

Many African American communities have suffered from generations of disproportionately low access to the building blocks of health. These factors include access to healthy food, insurance coverage, and adequate maternal and general healthcare. ​For patients with CHD​, problems such as reduced access to lifelong quality ​cardiac​ care affect outcomes.

“For example, poor access to prenatal health can have a detrimental effect on CHD postnatally. Prenatal diagnosis increases the level of preparation we can have for some of our more high-risk diseases,” said Dr. Ansah. “It's amazing the risk mitigation that comes from families being mentally prepared to take care of a child with significant CHD.”  

How health systems can move the needle toward equitable outcomes 

Many health systems have incorporated bias training into their health care provider education.  

“At Texas Children’s Hospital, I have witnessed more conversations directed towards educating providers on racial and ethnic disparities that exist within our field and how we as medical providers can reduce these disparities in order to create the best environment for serving our patients​,​” said Dr. Ansah. “The medical community as a whole has a responsibility to have transparent discussions about various shortcomings in how we deliver care to patients of minority communities and how this can be improved. Recognizing and screening for poorer SDOH is an important first step to understanding challenges our patients face.” 

The approach of an individual provider can make a big difference 

Health care management can influence ​the ​culture​ of a clinic or hospital​, but it is the work of the individual physicians, advanced practice providers and nursing staff to make personal course corrections to account for their own biases. This type of work fosters a medical community that encourages patients to participate in their own health.  

“As providers, we may know the best treatment course for a particular disease, but communicating and embarking on that treatment course in a way that is collaborative and effective for a patient requires compassion, effective listening and a great deal of humility,” said Dr. Ansah. 

To contact the Texas Children’s Heart Center, call 832-824-3278.