Abstract
IntroductionEthnic differences in the birth prevalence of congenital heart defects (CHDs) have been reported; however, studies of the contemporary UK population are lacking. We investigated ethnic variations in incidence of serious CHDs requiring cardiac intervention before 1 year of age.MethodsAll infants who had a cardiac intervention in England and Wales between 1 January 2005 and 31 December 2010 were identified in the national congenital heart disease surgical audit and matched with paediatric intensive care admission records to create linked individual child records. Agreement in reporting of ethnic group by each audit was evaluated. For infants born 1 January 2006 to 31 December 2009, we calculated incidence rate ratios (IRRs) for CHDs by ethnicity and investigated age at intervention, antenatal diagnosis and area deprivation.ResultsWe identified 5350 infants (2940 (55.0%) boys). Overall CHD incidence was significantly higher in Asian and Black ethnic groups compared with the White reference population (incidence rate ratios (IRR) (95% CIs): Asian 1.5 (1.4 to 1.7); Black 1.4 (1.3 to 1.6)); incidence of specific CHDs varied by ethnicity. No significant differences in age at intervention or antenatal diagnosis rates were identified but affected children from non-White ethnic groups were more likely to be living in deprived areas than White children.ConclusionsSignificant ethnic variations exist in the incidence of CHDs, including for specific defects with high infant mortality. It is essential that healthcare provision mitigates ethnic disparity, including through timely identification of CHDs at screening, supporting parental choice and effective interventions. Future research should explore the factors underlying ethnic variation and impact on longer-term outcomes.
Highlights
Ethnic differences in the birth prevalence of congenital heart defects (CHDs) have been reported; studies of the contemporary UK population are lacking
▸ Higher prevalence of CHDs in babies of British Asian compared with non-Asian ethnicity has been reported in some regional studies in England
▸ We report significant ethnic variation in the incidence of serious CHDs in English and Welsh infants, in national data set
Summary
Ethnic differences in the birth prevalence of congenital heart defects (CHDs) have been reported; studies of the contemporary UK population are lacking. The observed differences in reported birth prevalence between countries[1 3] may reflect causal factors, case ascertainment or the effectiveness of healthcare prevention. The birth prevalence of specific defects varies by racial or ethnic group,[4,5,6,7] and British Asian children have been reported to be at higher risk of complex CHDs than non-Asians.[8 9] Various factors have been proposed as influencing the association between ethnicity and health, including biology, migration, cultural and lifestyle factors, socioeconomic deprivation and inequitable access to health services.[10 11] Some authors have suggested that socioeconomic disadvantage and reduced access to diagnostic services underlie ethnic differences in CHD prevalence,[4 12 13] and deprivation has been associated with higher risk of all congenital anomalies, including CHDs, in the UK.[14]
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