Shelby Sferra

53 statements · 1 topic · summaries given as host listed separately

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Black patients had decreased in hospitals survival rates of 79% compared to 88% in white patients.

Cox regression analysis controlling for severity, socioeconomic status, and institutional covariants including hospital volume showed white CDH patients had comparable outcomes regardless of institutional diversity

clinical · Congenital Diaphragmatic Hernia

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Shelby's statements about Congenital Diaphragmatic Hernia 53 statements

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BOB in Ped Surg 2023 - AAP Winner - Shelby Sferra, MD

Quotation Health disparities driven by race and ethnicity are pervasive in healthcare and are known to impact all aspects of pediatric care. Open

Statement Health disparities driven by race and ethnicity are pervasive in healthcare and impact all aspects of pediatric care Open

Statement In CDH, racial and ethnic disparities affect care from prenatal diagnosis and surveillance through postnatal management Open

Statement The study cohort included 1,625 CDH patients from the PIS database between 2015 and 2020 Open

Statement Hospital volume was defined as less than 10 CDH cases per year as low volume and 10 or more cases as high volume Open

Statement Institutional racial and ethnic diversity was defined as the percentage of black and/or Hispanic CDH patients treated at each institution, stratified from less than 20% to greater than 40% Open

Statement Household incomes of black and Hispanic CDH patients were significantly lower than that for white patients Open

Statement White and Asian CDH patients had primarily commercial insurance, whereas black and Hispanic patients had largely Medicaid payer status Open

Statement Black CDH patients were born at significantly lower gestational ages and were more likely to be born preterm Open

Statement Black CDH patients had lower birth weights and lower Apgar scores compared to white patients Open

Statement Black CDH patients were cannulated to ECMO more often than white patients Open

Statement Black CDH patients were mechanically ventilated for longer and required pulmonary anti-hypertensives for longer compared to white patients Open

Statement Hispanic and Asian CDH patients did not show the same differences in disease severity markers when compared to white patients Open

Statement Black CDH patients were admitted for significantly longer, discharged home less often, and were more likely to require a tracheostomy at discharge Open

Statement Cox regression analysis controlling for severity, socioeconomic status, and institutional covariants including hospital volume showed white patients had comparable outcomes regardless of institutional diversity Open

Quotation Black patients had decreased in hospitals survival rates of 79% compared to 88% in white patients. Open

Statement Black CDH patients had decreased in-hospital survival rates of 79% compared to 88% in white patients Open

Statement Institutions with greater than 30% diversity conferred a protective effect against mortality for black CDH patients treated there Open

Statement Hispanic and Asian CDH patients had comparable survival rates to white patients at 88% and 92% respectively Open

Statement Institutions with diversity greater than 20% conferred a protective effect for Hispanic CDH patients Open

Statement Low institutional diversity levels (less than 20%) were associated with decreased survival in white, black, and Hispanic CDH patients Open

Quotation We demonstrate that treating a more racially and ethnically diverse patient population improves outcomes for black as well as Hispanic CDH patients without negatively impacting white patients. Open

Statement Treating a more racially and ethnically diverse CDH patient population improves outcomes for black and Hispanic patients without negatively impacting white patients Open

Statement Higher institutional diversity levels (between 31 and 40%) were associated with improved survival for white, black, and Hispanic CDH patients Open

Statement Institutional diversity differences were not observed in Asian CDH patients Open

Quotation I think that this needs to be something that started in medical school and then continues on in medical education and residency fellowship, um, and even at the attending level as well. Open

BOB Ped Surg 2023 - Shelby Sferra, AAP - Presentation

Quotation Health disparities driven by race and ethnicity are pervasive in healthcare and are known to impact all aspects of pediatric care. Open

Statement Health disparities driven by race and ethnicity are pervasive in healthcare and impact all aspects of pediatric care Open

Statement In congenital diaphragmatic hernia, racial and ethnic disparities affect care from prenatal diagnosis and surveillance through postnatal management Open

Statement The study cohort included 1,625 CDH patients from the PHIS database from 2015 to 2020, admitted on day of life zero with ICD diagnosis code for CDH and procedure code for repair Open

Statement Hospital volume was defined as less than 10 CDH cases per year as low volume and 10 or more cases as high volume Open

Statement Household incomes of black and Hispanic CDH patients were significantly lower than that for white patients Open

Statement White and Asian CDH patients had primarily commercial insurance, whereas black and Hispanic patients had largely Medicaid payer status Open

Statement Black CDH patients were born at significantly lower gestational ages and were more likely to be born preterm compared to white patients Open

Statement Black CDH patients had lower birth weights and lower Apgar scores compared to white patients Open

Statement Black CDH patients were cannulated to extracorporeal life support (ECMO) more often than white patients Open

Statement Black CDH patients were mechanically ventilated for longer and required pulmonary anti-hypertensives for longer compared to white patients Open

Statement Disease severity differences seen in Black CDH patients were not observed in Hispanic and Asian patients when compared to white patients Open

Statement Black CDH patients were admitted for significantly longer compared to white patients Open

Statement Black CDH patients were discharged home less often than white patients Open

Statement Black CDH patients were more likely to require a tracheostomy at the time of discharge compared to white patients Open

Quotation Black patients had decreased in hospitals survival rates of 79% compared to 88% in white patients. Open

Statement Black CDH patients had decreased in-hospital survival rates of 79% compared to 88% in white patients Open

Statement Hispanic and Asian CDH patients had comparable survival rates to white patients at 88% and 92% respectively Open

Statement Low institutional diversity levels (less than 20%) were associated with decreased survival in white, black, and Hispanic CDH patients Open

Statement Higher institutional diversity levels (between 31 and 40%) were associated with improved survival for white, black, and Hispanic CDH patients Open

Statement Institutional diversity effects on survival were not observed in Asian CDH patients Open

Statement Cox regression analysis controlling for severity, socioeconomic status, and institutional covariants including hospital volume showed white CDH patients had comparable outcomes regardless of institutional diversity Open

Statement Institutions with greater than 30% racial/ethnic diversity conferred a protective effect against mortality for black CDH patients treated there Open

Statement Institutions with diversity greater than 20% conferred a protective effect for Hispanic CDH patients Open

Statement Treating a more racially and ethnically diverse CDH patient population improves outcomes for black and Hispanic patients without negatively impacting white patients Open

Summaries Shelby gave as host · 7 summaries

Recaps of other experts' statements, not Shelby's own clinical position.

Summaries Shelby gave as host · Congenital Diaphragmatic Hernia 7 summaries

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BOB in Ped Surg 2023 - AAP Winner - Shelby Sferra, MD

Host summary Shelby Sferra summarizing the discussion: Existing studies on disparities in CDH show that black race is an independent risk factor for mortality and is further compounded by low socioeconomic status. Open

Host summary Shelby Sferra summarizing the discussion: Existing studies show that black race is an independent risk factor for mortality in CDH and is further compounded by low socioeconomic status Open

Host summary Shelby Sferra summarizing the discussion: I think that there are a lot of studies out there that show. That having patient physician concordance um and racial and ethnic disparities definitely improves outcomes for the minority patient population Open

Host summary Shelby Sferra summarizing the discussion: Studies show that patient-physician racial concordance improves outcomes for minority patient populations Open

Host summary Shelby Sferra summarizing the discussion: Patient-physician racial concordance has been shown to improve outcomes and survival in CDH cases Open

BOB Ped Surg 2023 - Shelby Sferra, AAP - Presentation

Host summary Shelby Sferra summarizing a resource: Existing studies on disparities in CDH show that black race is an independent risk factor for mortality and is further compounded by low socioeconomic status Open