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Health Disparities in Exercise Performance in Patients with Repaired Tetralogy of Fallot
Journal article   Open access   Peer reviewed

Health Disparities in Exercise Performance in Patients with Repaired Tetralogy of Fallot

Andrea L Jones, Rui Xiao, Ariel A Williamson, Hadiya Benn, Paul Stephens, Shivani M Bhatt, Laura Mercer-Rosa and Pamela F Weiss
Pediatric cardiology, v 46(8), pp 2513-2522
01 Dec 2025
DOI: https://doi.org/10.1007/s00246-024-03706-3
PMID: 39510985
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1007/s00246-024-03706-3View
Published, Version of Record (VoR) Open

Abstract

Adolescent Adult Black or African American - statistics & numerical data Child Exercise Test Exercise Tolerance - physiology Female Health Status Disparities Healthcare Disparities Humans Male Oxygen Consumption - physiology Retrospective Studies Tetralogy of Fallot - ethnology Tetralogy of Fallot - physiopathology Tetralogy of Fallot - surgery White - statistics & numerical data Young Adult
Black patients with tetralogy of Fallot (TOF) have higher mortality than White patients. Health disparities related to other patient-important outcomes, such as exercise performance, have not been studied in this population. We aimed to determine if there are racial disparities related to exercise performance in patients with TOF and to investigate possible mediators of those disparities. We conducted a retrospective single center study of patients aged 8-25 years with repaired TOF who completed maximal cardiorespiratory exercise tests between 2007 and 2020. The primary outcome was percent predicted oxygen consumption at peak exercise. We used linear regression to determine if race was associated with exercise performance. We used mediation analysis to investigate insurance coverage and neighborhood Child Opportunity Index as possible mediators of this relationship. The study cohort included 163 patients with TOF (136 non-Hispanic/Latinx White and 27 non-Hispanic/Latinx Black). In multivariable analysis, Black patients had a lower percent predicted peak oxygen consumption than White patients by 6.71 percentage points (95% CI - 12.71, - 0.70; p = 0.029). Mediation analysis revealed that the indirect effect of race through insurance coverage accounted for 34.1% of the decrease in exercise performance. Child Opportunity Index was not a statistically significant mediator. Black patients with TOF had worse exercise performance than White patients. Differences in insurance coverage accounted for a significant portion of this difference. Exercise performance is an important outcome for patients with TOF, and further investigation is needed to better understand this disparity and develop interventions to address it.

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
Pediatrics
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