Age‐ and Lesion‐Related Comorbidity Burden Among US Adults With Congenital Heart Disease: A Population‐Based Study

Abstract

BackgroundAs patients with congenital heart disease (CHD) are living longer, understanding the comorbidities they develop as they age is increasingly important. However, there are no published population‐based estimates of the comorbidity burden among the US adult patients with CHD.Methods and ResultsUsing the IBM MarketScan commercial claims database from 2010 to 2016, we identified adults aged ≥18 years with CHD and 2 full years of continuous enrollment. These were frequency matched with adults without CHD within categories jointly defined by age, sex, and dates of enrollment in the database. A total of 40 127 patients with CHD met the inclusion criteria (mean [SD] age, 36.8 [14.6] years; and 48.2% were women). Adults with CHD were nearly twice as likely to have any comorbidity than those without CHD (P<0.001). After adjusting for covariates, patients with CHD had a higher prevalence risk ratio for “previously recognized to be common in CHD” (risk ratio, 9.41; 95% CI, 7.99–11.1), “other cardiovascular” (risk ratio, 1.73; 95% CI, 1.66–1.80), and “noncardiovascular” (risk ratio, 1.47; 95% CI, 1.41–1.52) comorbidities. After adjusting for covariates and considering interaction with age, patients with severe CHD had higher risks of previously recognized to be common in CHD and lower risks of other cardiovascular comorbidities than age‐stratified patients with nonsevere CHD. For noncardiovascular comorbidities, the risk was higher among patients with severe than nonsevere CHD before, but not after, the age of 40 years.ConclusionsOur data underscore the unique clinical needs of adults with CHD compared with their peers. Clinicians caring for CHD may want to use a multidisciplinary approach, including building close collaborations with internists and specialists, to help provide appropriate care for the highly prevalent noncardiovascular comorbidities.

Clinical and socio-economic predictors of work participation in adult CHD patients

“…Considering other predictors of employment, we found that work participation was very strongly correlated with private insurance coverage, suggesting that a prior estimate of 49% employment among United States adults with CHD covered by private insurance plans may have overestimated work participation in the all-payor adults with CHD population. 7 Furthermore, we found that married adults with CHD were twice as likely to work as patients who were single. This result may represent selection into marriage on the basis of greater independence or social functioning, or discrimination on the marriage market against adults with CHD whose health condition limits their ability to work.…”

“…CHD is known to limit employment participation, even for relatively simple defects, and even after definitive surgical treatment. 7,21 However, prior studies in the United States have frequently been limited by tracking employment only among adults with CHD under cardiology follow-up. 3 With loss to cardiology follow-up becoming increasingly common as adults with CHD age, alternative strategies are needed to produce population-based estimates of employment among adults with CHD, as well as factors affecting employment.…”

“…Prior studies have reported that approximately half or more of adults with CHD are employed. However, studies including United States data have been limited by varying biases in sample selection, for example, sampling from patients under active cardiology follow-up, 3 sampling from patients enrolled in commercial insurance plans, 7 or sampling patients in a registry of heart transplant recipients. 8 Definitive population-based ascertainment of employment status among adults with CHD was achieved in Scandinavian studies using existing population registries, 21 but may not fully reflect factors affecting employment in the United States, such as the Black-White racial disparity identified in our study.…”

“…Prior studies indicate that adults with CHD have reduced work participation rates compared to adults without CHD: in one study, employment rates were 59% for adults with CHD with complex disease and 76% for adults with CHD with mild or moderate disease, compared to 83% in the general population. 4 In other studies, employment rates for adults with CHD ranged from 49% to 76%, [5][6][7] while in a post-transplant cohort, adults with CHD had very low rates of work participation, with socio-economic rather than clinical factors being the principal barriers to employment. 8 Adults with CHD may also experience barriers to work participation related to age, sex, comorbidities, social support, and knowledge of the disease.…”

Ambulatory Health Care Service Use and Costs Among Commercially Insured US Adults With Congenital Heart Disease

“…Adults with congenital heart disease (CHD) are a rapidly increasing population, 1 have many comorbidities, 2 and require frequent monitoring. 3 However, little is known about their ambulatory health care use and associated costs in the US.…”