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J Pediatr. 2019 Jun 5. pii: S0022-3476(19)30529-3. doi: 10.1016/j.jpeds.2019.04.046. [Epub ahead of print]

Racial and Ethnic Differences in Pediatric Pulmonary Hypertension: An Analysis of the Pediatric Pulmonary Hypertension Network Registry.

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Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA; Computational Health Informatics Program, Harvard Medical School & Boston Children's Hospital, Boston, MA. Electronic address:
Department of Pediatric Pulmonary Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, CO.
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Department of Pediatrics (Cardiology), Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Palo Alto, CA.
Department of Pediatrics (Pediatric Cardiology), Columbia University Medical Center, New York-Presbyterian Children's Hospital, New York, NY.
Department of Cardiology, Harvard Medical School, Boston Children's Hospital, Boston, MA.
Computational Health Informatics Program, Harvard Medical School & Boston Children's Hospital, Boston, MA.
Department of Pediatrics, University of Illinois, Chicago, IL.



To investigate racial and ethnic differences in pulmonary hypertension subtypes and survival differences in a pediatric population.


This was a retrospective analysis of a cohort of patients with pulmonary hypertension (aged ≤18 years) enrolled in the Pediatric Pulmonary Hypertension Network registry between 2014 and 2018, comprising patients at eight Pediatric Centers throughout North America (n = 1417).


Among children diagnosed after the neonatal period, pulmonary arterial hypertension was more prevalent among Asians (OR, 1.83; 95% CI, 1.21-2.79; P = .0045), lung disease-associated pulmonary hypertension among blacks (OR, 2.09; 95% CI, 1.48-2.95; P < .0001), idiopathic pulmonary arterial hypertension among whites (OR, 1.58; 95% CI, 1.06-2.41; P = .0289), and pulmonary veno-occlusive disease among Hispanics (OR, 6.11; 95% CI, 1.34-31.3; P = .0184). Among neonates, persistent pulmonary hypertension of the newborn (OR, 4.07; 95% CI, 1.54-10.0; P = .0029) and bronchopulmonary dysplasia (OR, 8.11; 95% CI, 3.28-19.8; P < .0001) were more prevalent among blacks, and congenital diaphragmatic hernia was more prevalent among whites (OR, 2.29; 95% CI, 1.25-4.18; P = .0070). An increased mortality risk was observed among blacks (HR, 1.99; 95% CI, 1.03-3.84; P = .0396), driven primarily by the heightened mortality risk among those with lung disease-associated pulmonary hypertension (HR, 2.84; 95% CI, 1.15-7.04; P = .0241).


We found significant racial variability in the prevalence of pulmonary hypertension subtypes and survival outcomes among children with pulmonary hypertension. Given the substantial burden of this disease, further studies to validate phenotypic differences and to understand the underlying causes of survival disparities between racial and ethnic groups are warranted.

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