Abstract 11577: Disparities in One-Year Mortality Among Infants With Cyanotic Congenital Heart Disease - Insights From Contemporary National Data

Abstract

Introduction: Racial inequities in congenital heart disease (CHD) are well documented. We examined the interplay between race, socioeconomic status (SES), and neonatal variables (prematurity and small for gestational age (SGA)) on 1-year mortality in infants with CHD. Hypothesis: SES and neonatal variables explain a significant part of observed racial disparities. Methods: Linked birth/death files from the Natality database for all liveborn neonates in the US were examined from 2014-2018. Infants with cyanotic CHD were identified. Non-Hispanic Black (NHB) infants were compared to non-Hispanic White (NHW) infants. The primary outcome was 1-year mortality. A composite measure of SES was created based on maternal education and insurance with a maximal level of 4 and a minimal level of 0 (least privileged). Other mediators included prematurity and SGA. A directed acyclic graph (Figure 1) was created a priori as a conceptual model. Additive structural equation modelling with bootstrapped confidence intervals was used to calculate the contribution of each pathway in Figure 1 to the primary outcome and percent mediated by SES, prematurity and SGA. Results: We identified 7,432 NHW and 1,452 NHB infants with cyanotic CHD. NHB race was associated with increased 1-year mortality (OR 1.40, 95% CI: 1.23-1.59) compared to NHW. Figure 1 shows the contribution of each pathway to one-year mortality. The effect of SES explained 35.9% (CI 22.0-67.3) of the mortality disparity between NHB and NHW race. The effect of SGA explained 16.5% (CI 8.8-30.2) and prematurity explained 12.0% (CI 5.4-26.1). The direct effect of NHB race was not significant (35.5%, CI -4.9 - 56.7). Conclusions: Less privileged SES and greater prematurity and SGA likely explain the 1-year mortality disparity in Black infants with cyanotic CHD. These findings identify targets for social intervention to decrease racial disparities in CHD outcomes.