Abstract 13115: Impact of Socioeconomic Status and Remoteness of Residence on Access to Cardiac Care for Pediatric Heart Disease in Alberta, a Jurisdiction of Universal and Centralized Cardiac Healthcare
Bibliographic record
Abstract
Introduction: Socioeconomic status (SES) and remoteness of residence (RoR) impact access to care and outcomes in congenital (CHD) and acquired (AHD) pediatric heart disease. Whether the universal, centralized Canadian healthcare system mitigates such inequities is unclear. We examined associations between SES and RoR on age at cardiac diagnosis (ACD), time to first intervention (TFI), and annual primary care (PCV) and cardiology (CV) visits as evidence of healthcare access in Alberta. Methods: All children born and diagnosed in Alberta with CHD or AHD from 2005-2017 were included. CHD was classified as mild, moderate, and severe base on the Bethesda Task Force definitions. Geospatial modelling was used to determine drive times (<60, 60-180, >180 minutes) to 1 of 2 provincial cardiac programs. Cox proportional hazards regression models were used to examine relationships between RoR and SES with ACD and TFI, and Poisson models using generalized estimating equations for annual PCV and CV. Results: Of 12,542 children, 9347 had mild, 1733 moderate and 717 severe CHD and 745 AHD. Most (8,833, 70.4%) lived <60 minutes to a cardiac center, and the largest proportion were in SES quintile 1 (least vulnerable, 3,074, 24.5%) and smallest in quintile 5 (most vulnerable, 2003, 16.0%). Median ACD was 1(IQR 0-108) days for mild, 0(0-54) days for moderate, and 0(0-0) days for severe CHD, and 340(41-1312) days for AHD. Intervention occurred in 1086(62.7%) with moderate CHD (TFI 63(7-150) days), 588(82.0%) with severe CHD (11(5-58) days), and 42 with AHD (1828(793-2866) days). ACD was impacted slightly by SES and only in AHD (Table). TFI and PCVs were not impacted by RoR or SES. Finally, CVs were inversely related to RoR for CHD and AHD. Conclusions: In Alberta, SES and RoR do not importantly impact ACD, TFI and PCVs among CHD and AHD patients. Greater RoR but not SES, however, is associated with fewer annual CVs, suggesting a need to optimize cardiac outreach services.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".