203 Racial and ethnic disparities among diagnosed critical congenital heart disease

Abstract

Critical congenital heart disease (CCHD) is defined as structural disease requiring surgery or catheter intervention during the first 30 days of life, can be diagnosed on prenatal ultrasound. Prenatal diagnosis can reduce morbidity and mortality. The purpose of this study was to determine if race and socioeconomic status (SES) impacts the rate of prenatal diagnosis of CCHD. We conducted a retrospective chart review of neonates at a single, tertiary pediatric cardiology practice from 2007-2018 with a diagnosis of CCHD. Neonates with prenatal diagnosis were compared to neonates diagnosed postnatally by: race/ethnicity, SES and infant mortality. SES was assessed using primary insurance and income quartile by zip code to provide estimated median household income. Seven diagnoses were targeted and divided into three groups based on prenatal ultrasound views that would be expected to make the diagnosis: four chamber, outflow tract, and other views. Data were analyzed using Fisher’s exact test and pairwise comparison if the Fischer’s test was statistically significant. A p-value < 0.05 was statistically significant. We identified 185 cases of CCHD; 102(55.2%) diagnosed prenatally, 83 (44.8%) diagnosed postnatally. Only three ethnic groups had adequate cases for analysis. Rate of prenatal diagnosis did not differ significantly by race/ethnicity (p=0.411) nor did postnatal diagnosis (p=0.499) (Table 1). Rates of prenatal or postnatal diagnosis also did not differ significantly by parental SES income (p=0.706). Infant mortality was higher in Blacks & Hispanics vs. Caucasians (p < 0.001) (Table 1 and 2). Infant mortality prior to 1 year of age was significantly associated with parental SES income: 71% had an annual salary <$50,000 vs. 27% (p <0.001; Table 2). Rate of prenatal detection of CCHD did not differ by race/ethnicity and SES. However, Black and Hispanic neonates had significantly higher infant mortality rates vs. Caucasian neonates. Parental SES was significantly lower in cases of infants who died in the first year of life.View Large Image Figure ViewerDownload Hi-res image Download (PPT)