Neighborhood Opportunity and Exercise-Related Cardiac Symptoms in Youth Athletes

BackgroundSudden cardiac arrest (SCA) disproportionately affects youths from lower socioeconomic neighborhoods. The underlying mechanisms for this disparity, particularly in youth athletes, remain unclear. While exercise-related cardiac symptoms serve as vital warning signs for identifying at-risk athletes, no studies have examined the prevalence of these symptoms across different socioeconomic strata. We hypothesized that social determinants of health, quantified by the Child Opportunity Index (COI), a validated multidimensional measure of neighborhood conditions, would be associated with cardiac symptoms identified during preparticipation screening. MethodsThis retrospective cross-sectional study analyzed data from the Simons Heart HeartBytes National Youth Cardiac Registry, a large preparticipation cardiac screening database. Youth athletes aged [&le;]17 years who completed standardized cardiovascular screening questionnaires were stratified by neighborhood opportunity level using the COI, a validated multidimensional measure of neighborhood conditions affecting child development. Multivariable logistic regression examined associations between COI quintiles and exercise-related cardiac symptoms, adjusting for demographics and comorbidities. ResultsAmong 10,000 youth athletes analyzed (median age 14.0 years; 38.8% female; 80.3% White), distribution across COI quintiles was 9.8% very low, 5.7% low, 7.7% moderate, 15.9% high, and 61.0% very high. Exercise-related chest pain and exercise-related fatigue demonstrated a higher prevalence in the lowest COI quintile (p<0.001). After adjustment for age, sex, race, physical activity, and comorbidities, participants from the very high COI quintile had significantly lower odds of exercise-related chest pain (p<0.001) and exercise-related fatigue (p=0.004) compared with the very low COI quintile. ConclusionsYouths from lower-opportunity neighborhoods were underrepresented in screening yet showed higher prevalence of exercise-related symptoms. Whether cardiac or noncardiac in origin, these disparities burden under-resourced communities with increased evaluations. Addressing screening inequities and understanding symptom patterns across socioeconomic strata are critical for equitable cardiovascular care. Prospective studies are needed to determine the clinical significance of these symptom patterns and develop equitable screening strategies.