This week we review a recent large scale administrative database study assessing racial and socioeconomic disparities in congenital heart disease outcomes in the US. How does patient neighborhood income affect outcomes? How does the presence of Down Syndrome mitigate risk? How does race or socioeconomic status affect length of stay? How can these data inform change to improve outcomes for all children with CHD? Professor Tara Karamlou of Cleveland Clinic Children's shares her deep insights into this critically important factor that may be every bit as important as the congenital heart anatomy. We also speak briefly in tribute to Dr. James Tweddell of Cincinnati Children's Hospital, who tragically passed last week. DOI: 10.1016/j.athoracsur.2021.04.008