Congential heart disease in the Medicaid population of Southern Arizona

Abstract

Birth prevalence of congenital heart disease (CHD) in the general population is approximately 8/1,000 live births. 1 Mayberry J.C. Scott W.A. Goldberg S.J. Increased birth prevalence of cardiac defects in Yuma, Arizona. J Am Coll Cardiol. 1990; 16: 1696-1700 Abstract Full Text PDF PubMed Scopus (21) Google Scholar , 2 Fixler D.E. Pastor P. Sigman E. Eifler C.W. Ethnicity and socioeconomic status impact on the diagnosis of congenital heart disease. J Am Coll Cardiol. 1993; 21: 1722-1726 Abstract Full Text PDF PubMed Scopus (62) Google Scholar , 3 Mitchell S.C. Korones S.B. Berendes H.W. Congenital heart disease in 56,109 births. Circulation. 1971; 43: 323-332 Crossref PubMed Scopus (943) Google Scholar , 4 Goldberg S.J. Lebowitz M.D. Graver E.J. Hicks S. An association of human congenital cardiac malformations and drinking water contaminants. J Am Coll Cardiol. 1990; 16: 155-164 Abstract Full Text PDF PubMed Scopus (136) Google Scholar , 5 Ferencz C. Rubin J.D. McCarter R.J. Brenner J.I. Neill C.A. Perry L.W. Hepner S.I. Downing J.W. Congenital heart disease prevalence at live birth. Am J Epidemiol. 1985; 121: 31-36 Crossref PubMed Scopus (792) Google Scholar , 6 Ferencz C, Rubin JD, Loffredo CA, Magee CA. Epidemiology of congenital heart disease. The Baltimore-Washington Infant Study 1981–1989, vol. 4. Perspectives Ped Cardiol Future, Mount Kisco, NY: Futura. Google Scholar , 7 Richards M.R. Merritt K.K. Samuels M.H. Langmann A.G. Congenital malformations of the cardiovascular system in a series of 6,053 infants. Pediatrics. 1955; 15: 12-32 PubMed Google Scholar , 8 Kerrebign K.F. Incidence in infants and mortality from congenital malformations of the circulatory system. Acta Pediatr Scand. 1966; 55: 316-320 Crossref PubMed Scopus (16) Google Scholar , 9 Carlgren L.E. The incidence of congenital heart disease in children born in Gothenberg, 1944–1950. Br Heart J. 1959; 21: 40-50 Crossref PubMed Scopus (136) Google Scholar Approximately 4 million children are born each year in the United States, and of these, almost 1.3 million are born into poverty. 10 Allen HD, Taubert KA, Deckelman RJ, Driscoll D, Dunningham A, Gidding SS, Herndon P, Kavey RW, Mullins C, Snider AR, Strong WB, Washington R. Poverty and cardiac disease in children. AJDC 1991;145:550–552. Google Scholar Assuming the same rate of CHD among children in poverty as in the general population, we would expect that approximately 10,400 infants with CHD would be born into families in poverty each year. Our clinical observations in Southern Arizona suggested that the prevalence of CHD may be increased among our Medicaid patients. Previous studies have not shown this to be true. 2 Fixler D.E. Pastor P. Sigman E. Eifler C.W. Ethnicity and socioeconomic status impact on the diagnosis of congenital heart disease. J Am Coll Cardiol. 1993; 21: 1722-1726 Abstract Full Text PDF PubMed Scopus (62) Google Scholar , 11 Chung C.S. Myrianthopoulos N.C. Yoshizaki H. Racial and prenatal factors in major congenital malformations. Hum Genet. 1968; 20: 44-60 Google Scholar However, these data were collected in 1968 and from 1971 to 1984 and therefore may not apply today under different socioeconomic and health care circumstances. This study was thus designed to determine the risk of CHD in patients without chromosomal disorders whose mothers were on Medicaid at the time of their conception and/or birth compared with the CHD prevalence in patients whose mothers were not on Medicaid during either time period. It is important to indicate that Medicaid in Arizona is offered only to families or persons who fall at or below 30% of the federal poverty level. Therefore, this study will assess the occurrence of CHD in the most impoverished group of families receiving Medicaid health care in Arizona. ∗ In Arizona, the Medicaid program is named the Arizona Health Care Cost Containment System (AHCCCS). We will refer to the program as Medicaid for ease of recognition to most readers.