Impact of Remoteness of Residence and Socioeconomic Status on Outcomes Among Children With Heart Disease in Alberta
Bibliographic record
Abstract
There is a paucity of data regarding the impact of remoteness of residence (RoR) and socioeconomic status (SES) on access to care and outcomes for children with congenital heart disease (CHD) or acquired heart disease (AHD) in a jurisdiction of universal health and centralized cardiac care. The primary objective was to examine whether RoR, SES, and their interaction impact access to health care and outcomes for children with heart disease in Alberta, Canada. This was a population-based study of children with CHD or AHD born between January 1, 2005, and December 31, 2017, in Alberta, Canada. Primary outcomes included age at diagnosis, time from diagnosis to intervention, number of annual primary care visits, annual cardiologist visits, annual emergency room visits, and survival. Multivariable Cox proportional hazards models identified independent associations. Longitudinal relationships between the number of annual physician visits and RoR and SES were assessed with multivariable Poisson models. We included 12,542 children (94% CHD, 6% AHD), 70.4% living <60 minutes’ drive of a cardiac center, and 10.9% residing >180 minutes away. RoR and SES were not associated with age at diagnosis, time from diagnosis to intervention, annual primary care visits, or transplant free survival for either CHD or AHD. Although SES demonstrated no impact, annual annual cardiologist visits were inversely related to RoR for CHD (60-180 minutes rate ratio [RR]: 0.83, 95% CI: 0.73-0.95; >180 minutes RR: 0.77, 95% CI: 0.67-0.88; P < 0.0001) and AHD (60-180 minutes RR: 0.63, 95% CI: 0.39-1.00; >180 minutes RR: 0.53, 95% CI: 0.34-0.84; P = 0.02). Additionally, increased annual emergency room visits were associated with further RoR ( P < 0.001) in both CHD and AHD and lower SES ( P < 0.001) only for those with CHD. Age at diagnosis, time to intervention, annual primary care visits, and transplant-free all-cause survival were not impacted by RoR or SES in children with heart disease. Greater RoR and SES, however, were associated with fewer annual cardiology visits and increased annual emergency room visits, which highlights the need for novel surveillance strategies for remote pediatric patients with heart disease.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".