Funded Projects

Advancing Equitable Pediatric Lipid Screening

Project Year

2026

City & State

Boston, Massachusetts

Program Name

Resident

Topic

Screening/Detection/Surveillance

Program Description

Problem  Pediatric dyslipidemia, including familial hypercholesterolemia (FH) and multifactorial dyslipidemia, is a common, under-recognized, and actionable risk factor for lifetime atherosclerotic cardiovascular disease (ASCVD). While FH affects approximately 1 in 250 children, multifactorial dyslipidemia affects nearly 1 in 10 U.S. children and is driven by genetic susceptibility, obesity, diet, physical inactivity, and adverse social and structural determinants of health. Together, these conditions account for a substantial proportion of early-life lipid abnormalities and cumulative LDL-cholesterol exposure that tracks into adulthood and contributes to ASCVD.  Despite strong evidence and 2018 AHA/ACC guidelines recommending universal lipid screening at ages 9 to 11 and 17 to 21 years (and risk-based selective screening), real-world screening rates remain low, with only 9 to 13 percent of U.S. children receiving lipid testing in large health systems. These gaps are especially pronounced in community and safety-net settings serving populations experiencing health disparities. Hispanic and non-Hispanic Black children have lower screening rates than non-Hispanic White children, and children from socioeconomically disadvantaged neighborhoods are less likely to be screened, diagnosed, or referred for follow-up.  While FH often anchors pediatric lipid screening, focusing solely on monogenic disease overlooks the much larger population of children with multifactorial dyslipidemia who could benefit from early identification and risk reduction. Inequitable implementation of screening perpetuates cardiovascular disparities across the life course.  

Primary Setting  This project partners with The Dimock Center and Boston Community Pediatrics, two Boston-based community clinics serving predominantly publicly insured, racially and ethnically minoritized children. These neighborhoods have noticeably lower Child Opportunity Index (COI) than other surrounding neighborhoods (see Appendix: COI map)  

Number of Children Affected  The Dimock Center and Boston Community Pediatrics care for several thousand pediatric patients annually. Hundreds of children at these sites are likely eligible for lipid screening each year (see Appendix: AAP Periodicity Schedule).  

Project Goal  The goal of this project is to assess the feasibility, acceptability, and workflow integration of implementing guideline-recommended pediatric lipid screening for both familial and multifactorial dyslipidemia in community-based primary care settings, with a deliberate focus on advancing health equity. This planning-focused, community-engaged project will generate actionable insights to inform future equitable screening and prevention initiatives.  

Proposed Intervention  Using a mixed-methods, cross-sectional design, the project will engage pediatric clinicians, case managers, social workers, and parents or caregivers through semi-structured interviews and focus groups. Data collection will explore barriers and facilitators to lipid screening, including clinic workflow constraints, caregiver understanding of cholesterol and cardiovascular risk, language and health literacy needs, follow-up care recommendation and logistics, and perceived costs or downstream implications for families.  The study will assess how social and structural determinants shape lipid screening uptake among marginalized children and share findings with community partners to co-develop site-specific protocols tailored to clinic workflows and patient populations.

Anticipated Outcomes  This project will identify equity-centered strategies to improve pediatric lipid screening, develop clinic-specific protocols for FH and multifactorial dyslipidemia, and strengthen partnerships with community health centers and families. The resulting practice-based evidence will support sustainable implementation and reduce disparities in early cardiovascular risk identification and prevention 

Project Goal

To improve equitable pediatric lipid screening and early cardiovascular risk identification in community-based primary care settings.

Project Objective 1

Identify and characterize key social, structural, and clinical barriers and facilitators influencing pediatric lipid screening (as recommended by AAP Bright Futures periodicity schedule) for familial hypercholesterolemia and multifactorial dyslipidemia in community-based clinics serving historically marginalized populations.

Project Objective 2

Improve clinic readiness to implement equitable pediatric lipid screening by co-developing site-specific, feasible screening protocols aligned with clinic workflows, resources, and patient populations.

Project Objective 3

During the project period, strengthen bidirectional partnerships with community clinics and families to support sustainable pediatric lipid screening and shared ownership of practice change.

AAP District

District I

Institutional Name

Boston Children's Hospital

Contact 1

Augustine Kang, MD, PhD