The Child Opportunity Index 2.0 and Disparities in Pediatric Cardiorespiratory Fitness.
Wang AP, Griffith G, Otto-Meyer S, Ward K.J Pediatr. 2024 May;268:113964. doi: 10.1016/j.jpeds.2024.113964. Epub 2024 Feb 17.PMID: 38369240
Take home points:
- Cardiac Opportunity Index 2.0 (COI) is being increasingly used to assess neighborhood-level characteristics that may affect pediatric medical disparities
- Lower COI was associated with lower cardiorespiratory fitness (CRF)
- Racial differences were not significant when adjusting for COI
Commentary from Dr. Jared Hershenson (Greater Washington DC), section editor of Pediatric Cardiology Journal Watch:
CRF as measured by peak oxygen consumption (pVO2) on cardiopulmonary exercise testing (CPET) is a known predictor of morbidity and mortality in many adult and pediatric studies. There have been some studies suggesting a racial disparity, with some biologic factors that may have contributed (eg. less aerobic muscle fibers or lower Hg), along with higher sedentary time. However, CRF can also be influenced by community level factors such as access to safe exercise and nutrition and whether these factors may be more significant than racial differences have not been well studied. The COI is a publicly available index of 29 domains that include education, health, environment, and socioeconomic factors that may impact health and child development. This study attempted to determine if lower COI is associated with lower CRF.
This was a retrospective review of CPET data from 2004-2022 in 1735 patients referred for cardiac symptoms that did not have any underlying congenital or acquired cardiac disease. All had maximal tests (defined as RER > 1.10). Demographic data and COI based on zip codes were collected. COI was categorized into quintiles. Table 1 shows the full demographics. CPET data showed statistically significantly lower peak VO2 and exercise duration in the lower COI groups. White and Latinx patients had a higher peak VO2 than black patients, but with multivariate analysis when COI was included, no difference in race was present. See Figure 1.
Given the neighborhood and socioeconomic factors contributing to decreased CRF and likely other risk factors for adult cardiac disease, it will be important from a provider and system level to address the barriers to regular and safe physical activity.
