Impact of rural residence and low socioeconomic status on rate and timing of prenatal detection of major congenital heart disease in a jurisdiction of universal health coverage

Abstract

What are the novel findings of this work?Of 1405 cases of major congenital heart disease (CHD), a prenatal diagnosis was made in 814. Residence in rural areas, compared with residence < 100 km from a tertiary fetal cardiology center, was associated with a 7% lower rate of prenatal diagnosis of major CHD and 19% higher rate of late diagnosis i.e. after 22 weeks' gestation. Low socioeconomic status was associated with lower prenatal-diagnosis rate in metropolitan regions and higher risk of prenatal diagnosis after 22 weeks overall. What are the clinical implications of this work?Despite universal healthcare in Alberta, Canada, socioeconomic and regional inequalities in prenatal fetal cardiac diagnoses exist. To improve CHD outcomes, further efforts are required to identify modifiable underlying reasons for these findings and to guide novel and targeted health service delivery.

Prevalence of Congenital Anomalies and Prenatal Diagnosis by Socioeconomic Level: Indicators of Inequality in Access to Elective Termination of Pregnancy for Fetal Anomalies

“…For example, a study conducted by Kaur and colleagues explored potential barriers to prenatal diagnosis among pregnant women in the province of Alberta, Canada. Despite the Canadian healthcare system providing universal healthcare coverage, the study found that individuals in the lowest quintile of socioeconomic status had the lowest rates of prenatal diagnosis, and that when prenatal diagnosis was performed, it was often delayed (Kaur et al 2022).…”

Prenatal Diagnosis Rate of Critical Congenital Heart Disease Remains Inadequate with Significant Racial/Ethnic and Socioeconomic Disparities and Technical Barriers

“…( 19) A recent study from Alberta, Canada found that distance from a tertiary care center and lower socioeconomic status were associated with lower likelihood of prenatal diagnosis. (20) Even in places with universal health insurance, such as Canada, those of lower socioeconomic status were less likely to be prenatally diagnosed, suggesting that lower socioeconomic status has a role to play that is independent of insurance status. In our study, mothers without health insurance were less likely to have infants with prenatal diagnosis.…”

Untangling the Complex Associations between Socioeconomic and Demographic Characteristics and Prenatal Detection and Outcomes in Congenital Heart Disease

“…Even within the Canadian universal healthcare system, disparities have been found in rates and timings of CHD diagnosis. Specifically, rural location is associated both with lower rates of prenatal detection and with prenatal detection occurring at a later gestational age [12].…”