Rachel J Shustak, Abigail Perlstein, Amanda S Artis, Alexis Z Tomlinson, Vicky Tam, Giordana Martino, Julie A Brothers
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引用次数: 0
Abstract
Objective: To examine the association of social determinants of health and age at heterozygous familial hypercholesterolemia (HeFH) diagnosis and treatment.
Study design: We performed a retrospective, single-center study of children with HeFH. Multivariable linear regression models were used to examine the association between Child Opportunity Index (COI) and age at HeFH diagnosis and statin initiation. Additional covariates included sex, race, ethnicity, health insurance type, primary language, body mass index (BMI) percentile, and LDL-C. To explore potential referral bias, we compared the COI of the study cohort with that of the institution's catchment area.
Results: We evaluated 577 patients. The median age at presentation was 12 (9, 14) years and the median LDL-C was 199 (169, 235) mg/dL; 58% were prescribed a statin at a median age of 13 (10, 15) years. There was no association between COI and the age at HeFH diagnosis or statin initiation. On multivariable analysis, Black race was associated with older age at HeFH diagnosis but not statin initiation compared with White race (adjusted estimate 1.1 +/- 0.50 yrs, p = 0.023). Higher LDL-C, male sex, and lower BMI percentile were associated with younger age at HeFH diagnosis and statin initiation. The COI of the study cohort was significantly higher than that of the catchment area (p < 0.001).
Conclusions: Black race was associated with older age at HeFH diagnosis; however, there were no differences in age at statin initiation. The COI of the cohort was significantly higher than that of the catchment area indicating that low COI populations are likely under-referred for HeFH evaluation.
期刊介绍:
The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy.
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