Community Socioeconomic Disadvantage and the Survival of Infants With Congenital Heart Defects

Abstract

Objectives We examined the association between survival of infants with severe congenital heart defects (CHDs) and community-level indicators of socioeconomic status. Methods We identified infants born to residents of Arizona, New Jersey, New York, and Texas between 1999 and 2007 with selected CHDs from 4 population-based, statewide birth defect surveillance programs. We linked data to the 2000 US Census to obtain 11 census tract–level socioeconomic indicators. We estimated survival probabilities and hazard ratios adjusted for individual characteristics. Results We observed differences in infant survival for 8 community socioeconomic indicators (P < .05). The greatest mortality risk was associated with residing in communities in the most disadvantaged deciles for poverty (adjusted hazard ratio [AHR] = 1.49; 95% confidence interval [CI] = 1.11, 1.99), education (AHR = 1.51; 95% CI = 1.16, 1.96), and operator or laborer occupations (AHR = 1.54; 95% CI = 1.16, 1.96). Survival decreased with increasing numbers of indicators that were in the most disadvantaged decile. Community-level mortality risk persisted when we adjusted for individual-level characteristics. Conclusions The increased mortality risk among infants with CHDs living in socioeconomically deprived communities might indicate barriers to quality and timely care at which public health interventions might be targeted.

Racial/Ethnic Differences in Survival of United States Children with Birth Defects: A Population-Based Study

“…Additional limitations include: (1) wide 95% CIs associated with the estimated survival probabilities for several defects among A/PI and AI/AN subgroups attributable to small sample sizes; and (2) lack of data on potentially important clinical factors (eg, timing and age of the child at initial diagnosis, the severity of the defect, and whether the child had isolated or nonisolated defects), demographic factors (eg, socioeconomic status 13 and health insurance payer 29 ) and hospital factors (eg, nursery care level at the hospital of delivery 35 ) that are also likely to play a role. Considering these limitations and the descriptive nature of the analysis, the survival estimates presented here should be interpreted cautiously.…”

Neighborhood Socioeconomic Status and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set

“…Recently, societal factors such as poverty, medical insurance, and maternal education have emerged as predictors of adverse outcomes in children with complex congenital heart disease (CHD) and may explain some of the difference in survival between children with similar clinical characteristics 9. Specifically, low socioeconomic status (SES) in children with SV physiology has been associated with higher early mortality6, 8 and lower quality of life10 after surgery, and other studies have found similar associations in the larger CHD population 11, 12, 13, 14, 15, 16. Nevertheless, existing studies examining SES have been limited by cross‐sectional or case–control study designs,14, 15 single center populations,7, 9, 10, 14, 15 or limited outcome assessment 6, 8.…”

Comparison of inhospital outcomes of pediatric heart transplantation between single ventricle congenital heart disease and cardiomyopathy

“…Andersen et al showed that children from lower‐income neighborhoods have worse mortality and higher resource utilization, including LOS and hospital costs, after cardiac surgery. Similarly, Kucik et al demonstrated an increased mortality in infants with CHD from socioeconomically disadvantaged communities. Among OHT patients, Singh and colleagues showed that low SES is associated with greater risk of rejection and OHT graft loss .…”