According to a study based on 2006 data from United Network of Organ Sharing in the US, 3,299 American children were on the heart transplant waiting list during an eight-year period up to 2006. Based on their ethnicity, the distribution is as follows:
- 58% white
- 20% black
- 16% Hispanic
- 3% Asian
- 3% others
Does this mean that more white children have heart problems and therefore need more heart transplantation? Actually no. The truth is actually sad and raises concerns about the role of race in health care.
“The most common reasons that children require heart transplants are serious congenital heart defects in children under the age of 1 and cardiomyopathy in those over the age of 10 years. These conditions tend to be equally distributed in children 1 to 10 years old [regardless of ethnicity]. Cardiomyopathy is a serious disease in which the heart muscle becomes inflamed and doesn’t work as well as it should.”
The reason why more white children are on the waiting list is because non-white children have a much higher likelihood of dying while waiting for a heart donor. If we look at the mortality figures, we see a completely different picture:
- Black children had a 60 percent greater chance of dying.
- Hispanics had a 50 percent higher mortality rate.
- Asians and others had a 100 percent to130 percent greater chance of dying.
If split between two ethnic groups white and non-whites, the non-white children clearly have a higher risk of dying before they can have a transplant.
I am mother to two kids who are partly of Asian ethnicity. It is heartbreaking to know that other kids like mine lose their chance for a heart transplant just because of the color of their skin.
However, the reasons for the disparity are many and complex and go beyond just the race issue. They include:
Socioeconomic factors. White children are more likely to belong to higher income families and better health insurance coverage. 58% of black children and 59% of Hispanic children have Medicaid insurance compared to 24% of white children. Those who have Medicaid have 20% higher mortality likelihood.
Cultural factors. Cultural and religious beliefs may play a role in the parents’ attitude towards treatments, including heart transplantation and “bridging therapies” while waiting for a heart donor.
Communication problems. Communications between healthcare providers and the patients (or parents of the patients) may play a big role. Language barriers as well as cultural and socioeconomic barrier can influence the efficiency of communications and therefore can cause delay in decision making.
Other unknown factors may play role and need to be addressed in future studies. However, this disparity due to race is very troubling and should be taken into account by health care providers when treating their young patients.
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