Cardiometabolic Health in Children with Pre-existing Dyslipidemia: Trends and Disparities

In order to evaluate the impact of a child's proximity to an urban center on their cardiometabolic health status and their response to treatment of cardiometabolic risk factors, retrospective review of the institutional pediatric lipid clinic database was conducted for all subjects receiving care from 1/1/2011 to 12/31/2023, with subgroup analysis of subjects with ≥ 2 clinical encounters and/or set of laboratory values. Subjects were classified as rural/urban and advantaged/middle/underserved based on their zip code using the Wisconsin Collaborative for Healthcare Quality classification system. Multivariate linear regression was used to examine disparities in baseline cardiometabolic health parameters by urban/rural groupings. Among subjects with multiple encounters, baseline and final available values were analyzed using paired t tests. 2419 subjects were included in the initial analysis with 75.4% living in urban environments and 51.9% having advantaged status. Urban advantaged children had lower BMI percentiles and waist circumference, but higher LDL-C values compared to other urban groups (p < 0.05). Rural advantaged and middle groups had higher TC, non-HDL-C, and LDL-C than the urban groups (p < 0.05). 1522 subjects had ≥ 2 encounters, with significant decreases in all lipid parameters (p < 0.006 for all). There was no change in fasting glucose, HbA1c, or ALT. Disparities in cardiometabolic parameters were seen at time of presentation based on rural/urban and advantaged/middle/underserved status, but all groups had similar improvements in cardiometabolic parameters throughout the course of treatment.