Associations Between Socioeconomic Context and Congenital Heart Disease Related Outcomes in Adolescents and Adults

Abstract

Little is known about the relation between socioeconomic factors and health outcomes in adults and adolescents with congenital heart defects (CHD). Population-level data from the Colorado CHD surveillance system from 2011 to 2013 was used to examine the association between area deprivation and outcomes including hospitalizations, emergency department visits, cardiac procedures, all-cause and cardiac-related mortality, and major adverse cardiac events. Socioeconomic context was measured by the Area Deprivation Index at census tract level. Missing race/ethnicity was imputed using the Bayesian Improved Surname Geocoding algorithm. Generalized linear models were utilized to examine health disparities across deprivation quintiles after adjusting for insurance type, race/ethnicity, age, gender, urbanicity, and CHD severity in 5,748 patients. Cases residing in the most deprived quintile had 51% higher odds of inpatient admission, 74% higher odds of emergency department visit, 41% higher odds of cardiac surgeries, and 45% higher odds of major adverse cardiac events compared with cases in the least deprived quintile. Further, rates of hospitalizations, emergency department admissions, and cardiac surgeries were elevated in the most deprived compared with the least deprived quintile. Mortality was not significantly different across quintiles. In conclusion, findings suggest significant health equity issues for adolescent and adults with CHD based on area-based deprivation.