US Mortality Attributable to Congenital Heart Disease Across the Lifespan From 1999 Through 2017 Exposes Persistent Racial/Ethnic Disparities

Abstract

Background: Congenital heart disease (CHD) accounts for approximately 40% of deaths in United States (US) children with birth defects. Previous US data from 1999-2006 demonstrated an overall decrease in CHD mortality. Our study aimed to assess current trends in US mortality related to CHD from infancy to adulthood over the last 19 years and determine differences by sex and race/ethnicity. Methods: We conducted an analysis of death certificates from 1999-2017 to calculate annual CHD mortality by age at death, race/ethnicity, and sex. Population estimates used as denominators in mortality rate calculations for infants were based on National Center for Health Statistics live birth data. Mortality rates in individuals ≥1 year of age utilized US Census Bureau bridged-race estimates as denominators for population estimates. We characterized temporal trends in all-cause mortality, mortality resulting directly due to and related to CHD by age, race/ethnicity, and sex using joinpoint regression. Results: There were 47.7 million deaths with 1 in 814 deaths due to CHD (n=58,599). While all-cause mortality decreased 16.4% across all ages, mortality resulting from CHD declined 39.4% overall. The mean annual decrease in CHD mortality was 2.6%, with the largest decrease for those age >65 years. The age-adjusted mortality rate decreased from 1.37 to 0.83 per 100,000. Males had higher mortality due to CHD than females throughout the study, although both sexes declined at a similar rate (~40% overall), with a 3-4% annual decrease between 1999 and 2009, followed by a slower annual decrease of 1.4% through 2017. Mortality resulting from CHD significantly declined among all races/ethnicities studied, although disparities in mortality persisted for non-Hispanic blacks versus non-Hispanic whites (mean annual decrease 2.3% versus 2.6%, respectively; age-adjusted mortality rate 1.67 to 1.05 versus 1.35 to 0.80 per 100,000, respectively). Conclusions: While overall US mortality due to CHD has decreased over the last 19 years, disparities in mortality persist for males compared to females and for non-Hispanic blacks compared to non-Hispanic whites. Determining factors that contribute to these disparities such as access to quality care, timely diagnosis, and maintenance of insurance will be important moving into the next decade.

Racial and socioeconomic disparities in congenital heart surgery: A research article

“…2 Hispanics have an increased odds of complications, while Black patients had more risk factors for failure to rescue when compared to their non-Hispanic White counterparts. 9,10 In Figure 1 2.04), and atrial septal defect with a hazard ratio of 1.34. 11 Overall non-Hispanic Black patients had an exacerbated decrease in survival rates with any tricuspid valve defects.…”

“…9 The male sex has been associated with a higher rate of complications, along with the need for multiple revisions. 9,10 Teaching hospitals have also been linked to an overall increase in mortality and higher levels of complications. 9,10 Maternal age over 35 years old was associated with a positive outcome, compared with those whose maternal age was under 18.…”

“…9,10 Teaching hospitals have also been linked to an overall increase in mortality and higher levels of complications. 9,10 Maternal age over 35 years old was associated with a positive outcome, compared with those whose maternal age was under 18. 2 Hispanics have an increased odds of complications, while Black patients had more risk factors for failure to rescue when compared to their non-Hispanic White counterparts.…”

Disparities in insurance coverage among hospitalized adult congenital heart disease patients before and after the Affordable Care Act

“…Certainly, part of the goal of the ACA implementation was to improve preventative care to reduce gaps in care, hospitalizations and mortality rates for individuals with chronic diseases. Given what is known about the association between lapses in care due to insurance issues and poorer outcomes in CHD (Gurvitz et al, 2013;Yeung et al, 2008) as well as documented evidence of ongoing disparities in mortality for patients with CHD (Lopez, Morris, Tejtel, Espaillat, & Salemi, 2020), we are hopeful that the demonstrated improvements in clinical outcomes following the ACA in the general population (Ahn, Hussein, Mahmood, & Smith, 2020;Breslau, Stein, Han, Shelton, & Yu, 2018;French, Homer, Gumus, & Hickling, 2016;Lau, Adams, Park, Boscardin, & Irwin, 2014) have a similar effect in this high-risk patient group.…”

The Year in Review: Anesthesia for Congenital Heart Disease 2020

“…In 2020, Lopez et al have updated this important work to contemporize outcomes from 1999 to 2017, utilizing the same data sets. 23 There was a slower annual decrease in mortality rates attributable to CHD (1.4%) from 2010 to 2017 compared with 1999 to 2009 (3% to 4%). Between 1999 and 2017, males had a higher age-adjusted mortality attributable to CHD compared with females.…”