Risk of Death for US Infants With Congenital Heart Disease Varies Geographically

By Linda Carroll

June 09, 2021

(Reuters Health) - The likelihood infants will die from congenital heart disease may in part depend on where they live, a U.S. study suggests.

An analysis of data from nearly 14,000 infants who died from congenital heart disease suggests that children with the condition in Kentucky and Mississippi are at greatest risk while three New England states had the lowest risk levels, according to the results published in The Lancet Child & Adolescent Health.

"The main take-home message is that social determinants of health impact outcome for infants with congenital heart disease," said study coauthor Dr. Jonathan Kaltman, senior scientific advisor for data science in the division of cardiovascular sciences at the National Heart, Lung, and Blood Institute in Bethesda, Maryland.

"Specifically, we showed that infants of mothers that lived in areas with higher poverty or areas that were farther from top-performing cardiac centers had worse infant mortality due to congenital heart disease," Dr. Kaltman said in an email.

Congenital heart disease occurs in 1% of livebirths per year in the U.S., with about 25% of these infants requiring surgery or invasive procedures during the first year of life, Dr. Kaltman and his team note.

To look at the potential impact of geography on whether a child with congenital heart disease survives, Dr. Kaltman and his colleagues turned to data from the U.S. National Center for Health Statistics. The team focused on the cohort of livebirths from January 1, 2006 to December 31, 2015. They included all deaths of infants younger than 365 days born to U.S. residents in the analysis.

During the study period, there were 13,988 infant deaths attributed to congenital heart disease and 40,847,089 livebirths, which resulted in an overall observed infant mortality rate due to congenital heart disease of 0.34 per 1,000 live births. The overall observed infant mortality rate due to congenital heart disease decreased over time from 0.38 per 1,000 in 2006 to 0.33 per 1,000 in 2015.

Overall, male infants had a higher rate of mortality due to congenital heart disease than female infants (0.37 versus 0.32 per 1,000 livebirths). The rates for infants born to mothers who were non-Hispanic Black (0.44 per 1,000 livebirths), Hispanic (0.35 per 1,000 live births), and in the Other category (0.36 per 1,000 live births) was higher than for infants born to non-Hispanic white mothers (0.31 per 1,000).

Infant mortality rates were progressively lower with higher levels of maternal education. For infants born to mothers with a masters, doctorate, or professional degree, the mortality rate was 0.20 per 1,000 livebirths, as compared with 0.42 per 1,000 livebirths among infants born to a mother with education to 12th grade or lower with no diploma.

Mortality rates were also higher for infants born to mothers with a residence in a county in the highest quintile of poverty than in the lowest quintile (0.40 vs 0.28 per 1000 livebirths). The rate was also lower if the mother lived proximal to a top-ranked pediatric cardiac center (PCC-T50) than if she was not proximal to any PCC (0.30 versus 0.38 per 1,000). Kentucky and Mississippi had the greatest proportion of counties with a congenital heart disease mortality rate above the 95th percentile while all counties in Connecticut, Massachusetts and Rhode Island were in the 5th percentile.

It's possible that the disparities can be remedied, Dr. Kaltman said. "First, we need to determine which infants are at highest risk for poor outcomes," he added. "This study shows that those risk factors are not just medical, but they are also socioeconomic and demographic. Then, we need to target interventions to these high-risk groups. Further study is needed to determine what the most appropriate interventions might be, but they could possibly include home nursing visits, family education, and/or frequent telemedicine check-ins."

It's not surprising that poverty is related to a greater mortality risk for these infants, said Dr. Albert Wu, an internist and a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

"It's sad to say this is the kind of result we are becoming used to seeing," Dr. Wu said. "It's tragic that this affects some of the tiniest and most vulnerable people in the U.S."

Dr. Wu was happy to see that pediatric cardiac centers can make a difference and help infants with congenital heart disease survive.

With regard to improving the situation for these infants, "our planning processes should be robust enough to locate cardiac centers within reach of as many regions of the country as possible," Dr. Wu said. "The question about dealing with poverty is more complicated. The article suggests a need to improve the care of children living in poverty but focusing on medical care is too narrow a view of the problem. There are many other ways that factors associated with poverty decrease the health and longevity of children. We need to think more broadly about addressing the root causes of those so-called social determinants of health if we are to improve health outcomes for these patients and the rest of our population."

SOURCE: https://bit.ly/357I7qR and https://bit.ly/3g6axIp The Lancet Child & Adolescent Health, online May 27, 2021. (Editing by Christine Soares)