The Impact of Social Determinants of Health on Transition from Pediatric to Adult Cardiology Care

Social determinants of health (SDoH) are the economic, social, environmental, and psychosocial factors that influence health. Adolescents and young adults with congenital heart disease (CHD) require lifelong cardiology follow-up and therefore coordinated transition from pediatric to adult healthcare systems. However, gaps in care are common during transition, and driven in part by pervasive disparities in SDoH including race, ethnicity, socioeconomic status, access to insurance, and remote location of residence. These disparities often co-exist, and compound challenges faced by patients and families. For example, Black and Indigenous individuals are more likely to be subject to systemic racism and implicit bias within healthcare and other settings, be unemployed and poor, have limited access to insurance, and have a lower likelihood of transfer of care to adult CHD specialists. SDoH are also associated with acquired cardiovascular disease, a co-morbidity that adults with CHD face. This review summarizes existing evidence regarding the impact of SDoH on transition to adult care and proposes strategies at the individual, institutional, and population/system levels to reduce inequities faced by transition-age youth. These include routinely screening for SDoH in clinical settings with referral to appropriate services for those who screen positive, providing formal transition education for all transition-age youth including training on navigating complex medical systems, creating satellite cardiology clinics to facilitate access to care for those who live remote from tertiary centers, advocating for lifelong insurance coverage where applicable, mandating cultural sensitivity training for providers, and increasing the diversity of healthcare providers in pediatric and adult CHD care.