Background: Congenital heart disease (CHD) accounts for approximately 40% of deaths in United States (US) children with birth defects. Previous US data from 1999-2006 demonstrated an overall decrease in CHD mortality. Our study aimed to assess current trends in US mortality related to CHD from infancy to adulthood over the last 19 years and determine differences by sex and race/ethnicity. Methods: We conducted an analysis of death certificates from 1999-2017 to calculate annual CHD mortality by age at death, race/ethnicity, and sex. Population estimates used as denominators in mortality rate calculations for infants were based on National Center for Health Statistics live birth data. Mortality rates in individuals ≥1 year of age utilized US Census Bureau bridged-race estimates as denominators for population estimates. We characterized temporal trends in all-cause mortality, mortality resulting directly due to and related to CHD by age, race/ethnicity, and sex using joinpoint regression. Results: There were 47.7 million deaths with 1 in 814 deaths due to CHD (n=58,599). While all-cause mortality decreased 16.4% across all ages, mortality resulting from CHD declined 39.4% overall. The mean annual decrease in CHD mortality was 2.6%, with the largest decrease for those age >65 years. The age-adjusted mortality rate decreased from 1.37 to 0.83 per 100,000. Males had higher mortality due to CHD than females throughout the study, although both sexes declined at a similar rate (~40% overall), with a 3-4% annual decrease between 1999 and 2009, followed by a slower annual decrease of 1.4% through 2017. Mortality resulting from CHD significantly declined among all races/ethnicities studied, although disparities in mortality persisted for non-Hispanic blacks versus non-Hispanic whites (mean annual decrease 2.3% versus 2.6%, respectively; age-adjusted mortality rate 1.67 to 1.05 versus 1.35 to 0.80 per 100,000, respectively). Conclusions: While overall US mortality due to CHD has decreased over the last 19 years, disparities in mortality persist for males compared to females and for non-Hispanic blacks compared to non-Hispanic whites. Determining factors that contribute to these disparities such as access to quality care, timely diagnosis, and maintenance of insurance will be important moving into the next decade.

Introduction Microaggressions and their impact have been documented in minority college students; however, little is known about the experience of medical students. This study reports the prevalence and understanding of microaggressions among medical students at the University of Florida College of Medicine (UFCOM), while gaining insights into experiences of medical students dealing with microaggressions. Method A nine-question survey was sent out to all medical students at the UFCOM in the spring of 2017 to understand their experiences with microaggressions. The authors used simple statistics and chi-test to analyze the demographic data and an inductive thematic qualitative analysis was performed on the open-ended responses to study medical students’ understanding of the term, experiences, and impact of microaggressions. Results The response rate was 64% ( n = 351/545). Fifty-four percent reported experiencing microaggressions, of those the majority were female students (73% compared with 51% among male students, p = 0.0003); for female students from minority backgrounds this was 68% and for white female students 76% ( p = 0.2606). Microaggressions are more common in the second year of medical school (30%), followed by the third year (23%). Most students were able to recognize and identify microaggressions, but some denied the concept existed, attributing concerns about microaggressions to a culture promoting oversensitivity and political correctness. Students described microaggressions related to sexism; religion; skin colour; and ethnicity. Students described indifference, emotional reactions and denial of the event as coping mechanisms. Conclusion Microaggressions are prevalent on a day-to-day basis among medical students with female students from a minority background as well as white female students experiencing more microaggressions. Further research is needed to explore interventions to counter microaggressions in order to ensure a healthy learning environment.