Background: The concept of quality of life (QoL) covers physical/psychological health, level of independence, social relations, environmental factors, and individual beliefs. Objective: This study aimed to investigate health-related QoL in children with cyanotic congenital heart disease (CCHD) and to determine socioeconomic inequality in CCHD. Patients and Methods: This case-control study was conducted at Children’s Heart Hospital and Primary Healthcare Centers on 400 children (200 healthy and 200 with CCHD) from December 01, 2021, to May 01, 2022, in Sulaimaniyah, Iraq. For this purpose, a 5 Likert Scale QoL questionnaire was used to collect the data of patients and their parents through a direct face-to-face interview. Then, children's sociodemographic data and parents' socioeconomic status (SES) was investigated together with another 22 items in 6 domains. Results: Studied children had equal gender and age distribution. CCHD was more prevalent in families with low SES, and ECI was - 0.44. Children with CCHD had significantly lower mean scores for the overall QoL dimension (Mean rank=124) compared to healthy children (Mean rank=277) (P≤0.001). About 91.5% of CCHD patients had poor QoL compared to 7.5% of healthy children. The mean SpO2 levels of healthy children were 9 % higher than CCHD children (P<0.001). Moreover, parents with CCHD children stated that 57% of their children had moderate to excellent health, while those with healthy children reported 98% (P=0.001). Conclusions: Significant deficits in all QoL dimensions were found in CCHD children. Also, we discovered an inequality distribution of CCHD in families with lower SES.