The role of socioeconomic status and the development of congenital heart disease: A scoping review

Abstract

Introduction: Congenital heart disease (CHD) is the most common congenital anomaly affecting 1% of all live births of which the etiology remains unknown. The incidence is higher in developing countries likely related to low literacy, poverty and higher exposures to hazardous environmental nuisances. The role of socioeconomic status (SES) in CHD development has recently received attention. To gain the breadth of knowledge generated from existing publications, we undertook a scoping review of studies examining the relationship between SES and CHD. Methods: We searched databases using individual or combination of keywords which included non-Medical Subject Heading (non-MeSH) and MeSH terms. We included original observational studies using cohort, case control or ecologic study designs written in English and from 1980-2017. Results: We identified 26 studies, most of which were conducted in developed economies with very few from developing economies. The majority (18/26, 69%) examined individual maternal SES variables and the risk of CHD, whilst fewer (4/26, 15%) examined associations with SES at the area level or neighborhood level and others (4/26, 15%) examined the individual, family and neighborhood SES levels to weigh the relative contribution of each SES level in CHD development. Individual maternal low education and low skilled occupation were associated with CHD in half of the studies and another half of the studies found no associations between these variables and CHD. Evidence regarding the influence of neighborhood SES alone or multiple SES variables has been inconclusive as well. Conclusion: There is a paucity of studies from both developed and even more so from developing countries that have examined the influence of SES in CHD development. More knowledge regarding the contribution of various SES measures (i.e., individual, area level, and combinations) on CHD occurrence is required before relevant and effective interventions can be implemented.

Associations of congenital heart disease with deprivation index by rural-urban maternal residence: a population-based retrospective cohort study in Ontario, Canada

“…Similarly, infants whose mothers lived in the neighbourhoods with the lowest percentage of people with a university or higher degree had a higher chance of CHD (adjusted OR: 1.34, 95% CI: 1.24-1.44) when compared to those living in the neighbourhoods with the highest percentage of people with a university of higher degree [14]. Studies from other countries showed similar results [22,23]. One recent study conducted in the United States found the incidence of CHD among infants to be higher in the most socially and economically disadvantaged neighbourhoods (quartile 4) compared to the least disadvantaged neighbourhoods (quartile 1) (adjusted OR 1.31, 95% CI: 1.21-1.41) [46].…”

“…A meta-analysis including data from 33 studies found that lower levels of maternal education and family income, and maternal exposure to certain occupations increased the risk of CHD by 11%, 5% and 51%, respectively [22]. However, the results were not consistent across all geographic areas and SES indicators [22,23]. The mechanism of this relationship remains unclear.…”

“…Although numerous studies have been published regarding socioeconomic inequities, geographic residence variation, and the risk of CHD, findings are inconsistent [18,22,23]. The interrelationship between rural-urban, socioeconomic status (SES), and CHD remains unclear [18,22,23].…”

“…Although numerous studies have been published regarding socioeconomic inequities, geographic residence variation, and the risk of CHD, findings are inconsistent [18,22,23]. The interrelationship between rural-urban, socioeconomic status (SES), and CHD remains unclear [18,22,23]. In the past, we have used multiple SES indicators to measure maternal SES [14]; however, SES has multiple dimensions, and no single SES indicator can represent all perspectives, which may also lead to inconsistent findings regarding associations between SES and CHD [27].…”

Nonmedical Determinants of Congenital Heart Diseases in Children from the Perspective of Mothers: A Qualitative Study in Iran

“…In recent years, nonmedical health determinants have been shown to contribute to health and disease outcomes and lead to congenital anomalies [ 17 , 18 ]. Poverty, social exclusion, and unhealthy behaviors are associated with congenital anomalies such as congenital heart abnormalities, although in this regard, the results of research are different [ 10 ].…”