The impact of national sociodemographic variables on access to cardiac medicine and surgery in Haiti: Evidence from Haiti Cardiac Alliance

Abstract Background In Haiti, cardiovascular disease is a leading cause of morbidity and mortality, with congenital and rheumatic heart disease comprising a large portion of disease burden. However, domestic disparities in cardiac care access and their impact on clinical outcomes remain poorly understood. We analyzed population-level sociodemographic variables to predict cardiac care outcomes across the ten Haitian administrative departments. Methods This cross-sectional study combines data from a 2016-17 Haitian national health survey with aggregate outcomes from the Haiti Cardiac Alliance (HCA) database (n = 1817 de-identified patients). By univariate and multivariate regression, the proportion of HCA patients belonging to three clinical categories (active treatment, lost to follow-up, deceased preoperatively) was modeled in relation to six population-level survey variables selected a priori. Results In univariate analysis, higher departmental rates of childhood growth retardation were associated with a lower proportion of patients in active care (OR = 0.979 [0.969,0.989], p = 0.002) and a higher proportion of patients lost to follow-up (OR = 1.016 [1.006,1.026], p = 0.009). In multivariate analysis, the proportion of department patients in active care was inversely associated with qualified prenatal care (OR = 0.980 [0.971,0.989], p = 0.005), child growth retardation (OR = 0.977 [0.972,0.983]), p = 0.00019), and travel time to nearest healthcare facility in an emergency (OR = 0.997 [0.993,1.001], p = 0.16); it was directly associated with adult employment (OR = 1.006 [0.996,1.015], p = 0.28). Similar multivariate results were obtained for departmental rates of loss to follow-up and preoperative mortality. Conclusions Population data on multiple sociodemographic variables meaningfully predicted domestic disparities in HCA clinical outcomes by region. These findings may help to identify underserved areas in Haiti, for whom targeted resources may increase continuity of care and success of cardiac care interventions. This approach may also be generalizable to other forms of specialty care in Haiti and other low-income countries.