Abstract 9217: Characterizing Barriers to Fetal Cardiac Care Within the Greater Chicago Area

Abstract

Introduction: Prenatal diagnosis (PND) is key in the treatment of congenital heart disease (CHD), the most common birth defect. National PND rates remain only ~50%, yet barriers to PND are region-specific. We aimed to identify sociodemographic barriers to CHD PND within the Greater Chicago Area. Methods: Infants < 12 months of age with CHD that could be diagnosed by fetal echocardiography, who received cardiac surgery between 2016 and 2020, were identified from the Society of Thoracic Surgeons (STS) database at Lurie Children’s Hospital. Sociodemographic variables of maternal-infant dyads were collected from STS and electronic medical records. ZIP codes were linked to US Census Bureau data. Multivariable logistic regression and mediation analysis were used to analyze relationships between sociodemographic variables and prenatal diagnosis. Results: In total, 558 dyads met inclusion criteria. Of these, 58% had PND. In unadjusted analysis, those with private insurance were 1.6 times likelier to have PND than those with public insurance (95% CI 1.1-2.2, Table 1). However, in adjusted analysis (Table 1), payor status was an effect modifier of the associations between critical CHD status (public vs. private payor OR 11.4 vs 3.1) and maternal ZIP within a far suburb (public vs. private payor OR 15.9 vs. 0.7) on PND. There were no differences in PND by maternal race or ethnicity. In a secondary mediation analysis, the indirect effect of receiving transportation aid mediated 54% (p=0.005) of the total effect between maternal public insurance status and PND. Conclusions: Maternal payor status is strongly associated with CHD PND, and modifies the relationship between geographic factors, critical CHD, and PND in the Greater Chicago area. For those residing in far suburbs, PND is paramount for access to surgical care. Transportation aid lies in the causal pathway between payor status and PND. Future study will identify modifiable factors to improve access to CHD PND at the state level.