Racial/Ethnic Disparities in Risk of Early Childhood Mortality Among Children With Congenital Heart Defects

BACKGROUND: Infants with congenital heart defects (CHDs) have increased risk of childhood morbidity and mortality. However, little is known about racial/ethnic differences in early childhood mortality. PATIENTS AND METHODS: We conducted a retrospective cohort study with data from the Texas Birth Defect Registry on 19 530 singleton, live-born infants with a CHD and born January 1, 1996, to December 31, 2003, to non-Hispanic (NH) white, NH black, and Hispanic women. Texas Birth Defect Registry data were linked to Texas death records and the National Death Index to ascertain deaths between January 1, 1996, and December 31, 2005. Kaplan-Meier survival estimates were computed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated from multivariable Cox-proportional hazard regression models to determine the effect of maternal race/ethnicity on mortality for selected CHD phenotypes. RESULTS: After adjusting for covariates, compared with NH white children, NH black children had increased early childhood mortality risk for transposition of the great arteries (HR: 2.04 [95% CI: 1.40–2.97]), tetralogy of Fallot (HR: 1.85 [95% CI: 1.09–3.12]), pulmonary valve atresia without ventricular septal defect (VSD) (HR: 2.60 [95% CI: 1.32–5.12]), VSD (HR: 1.56 [95% CI: 1.19–2.03]), and atrial septal defect (HR: 1.34 [95% CI: 1.08–1.66]). Hispanic children had higher mortality risk for pulmonary valve atresia without VSD (HR: 1.76 [95% CI: 1.06–2.91]) and hypoplastic left heart syndrome (HR: 1.51 [95% CI: 1.13–2.02]). CONCLUSIONS: We provide evidence that supports racial/ethnic disparities in early childhood mortality among infants with CHDs. Identifying infants with the greatest risk of early childhood mortality will facilitate development of interventions and policies to mitigate these risks.

[1]  G. Flores.  Racial and Ethnic Disparities in the Health and Health Care of Children , 2010, Pediatrics.

[2]  J. Salemi,et al.  Mortality in First 5 Years in Infants With Functional Single Ventricle Born in Texas, 1996 to 2003 , 2010, Circulation.

[3]  R. Thiagarajan,et al.  Racial and Ethnic Differences in Mortality in Children Awaiting Heart Transplant in the United States , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[4]  A. Hoffmeier,et al.  Do the Age of Patients with Tetralogy of Fallot at the Time of Surgery and the Applied Surgical Technique Influence the Reoperation Rate? , 2009, Herz Kardiovaskuläre Erkrankungen.

[5]  R. Thiagarajan,et al.  Waiting List Mortality Among Children Listed for Heart Transplantation in the United States , 2009, Circulation.

[6]  S. Kerry,et al.  Perineal sensation: an important predictor of long-term outcome in open spina bifida , 2006, Archives of Disease in Childhood.

[7]  K. Gauvreau,et al.  Racial and Ethnic Disparities in Mortality Following Congenital Heart Surgery , 2006, Pediatric Cardiology.

[8]  R. Kirby,et al.  Survival of Infants With Neural Tube Defects in the Presence of Folic Acid Fortification , 2006, Pediatrics.

[9]  Jeffrey Geppert,et al.  Mortality among very low-birthweight infants in hospitals serving minority populations. , 2005, American journal of public health.

[10]  W. Mahle,et al.  Disparities in outcome for black patients after pediatric heart transplantation. , 2005, The Journal of pediatrics.

[11]  Gregory D. Stevens,et al.  Disparities in Access to Care and Satisfaction among U.S. Children: The Roles of Race/Ethnicity and Poverty Status , 2005, Public health reports.

[12]  G. Flores,et al.  Racial and Ethnic Disparities in Early Childhood Health and Health Care , 2005, Pediatrics.

[13]  P. Newacheck,et al.  Prevalence and characteristics of children with special health care needs. , 2004, Archives of pediatrics & adolescent medicine.

[14]  C. Brach,et al.  The role of race and ethnicity in the State Children's Health Insurance Program (SCHIP) in four states: are there baseline disparities, and what do they mean for SCHIP? , 2003, Pediatrics.

[15]  C. Brach,et al.  The Role of Race and Ethnicity in the State Children’s Health Insurance Program (SCHIP) in Four States: Are There Baseline Disparities, and What Do They Mean for SCHIP? , 2003, Pediatrics.

[16]  P. Wise.  The anatomy of a disparity in infant mortality. , 2003, Annual review of public health.

[17]  Jill G Joseph,et al.  Racial and ethnic disparities in pediatric appendicitis rupture rate. , 2003, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[18]  M. Cleves,et al.  First-year survival of infants born with congenital heart defects in Arkansas (1993-1998): a survival analysis using registry data. , 2003, Birth defects research. Part A, Clinical and molecular teratology.

[19]  Christopher S Kim,et al.  Influence of insurance status and vaccine cost on physicians' administration of pneumococcal conjugate vaccine. , 2003, Pediatrics.

[20]  P. Oakeshott,et al.  Long-term outcome in open spina bifida. , 2003, The British journal of general practice : the journal of the Royal College of General Practitioners.

[21]  R. D. Merz,et al.  First‐year mortality rates for selected birth defects, Hawaii, 1986–1999 , 2003, American journal of medical genetics. Part A.

[22]  S. Rasmussen,et al.  Population-based analyses of mortality in trisomy 13 and trisomy 18. , 2003, Pediatrics.

[23]  K. Jenkins,et al.  Risk of Death for Medicaid Recipients Undergoing Congenital Heart Surgery , 2003, Pediatric Cardiology.

[24]  K. Gauvreau,et al.  Regional Racial and Ethnic Differences in Mortality for Congenital Heart Surgery in Children May Reflect Unequal Access to Care , 2003, Pediatric Cardiology.

[25]  S. Sanders,et al.  Racial and geographic disparities in timing of bidirectional Glenn and Fontan stages of single-ventricle palliation. , 2002, Journal of the National Medical Association.

[26]  L. Claudio,et al.  The health of Latino children: urgent priorities, unanswered questions, and a research agenda. , 2002, JAMA.

[27]  P. Newacheck,et al.  Racial and ethnic disparities in access to care for children with special health care needs. , 2002, Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.

[28]  W. Nembhard,et al.  Patterns of first-year survival among infants with selected congenital anomalies in Texas, 1995-1997. , 2001, Teratology.

[29]  L. Paulozzi,et al.  Survival of infants with spina bifida: a population study, 1979-94. , 2001, Paediatric and perinatal epidemiology.

[30]  N. Kressin,et al.  Racial Differences in the Use of Invasive Cardiovascular Procedures: Review of the Literature and Prescription for Future Research , 2001, Annals of Internal Medicine.

[31]  J. David Erickson,et al.  Mortality Associated With Congenital Heart Defects in the United States: Trends and Racial Disparities, 1979–1997 , 2001, Circulation.

[32]  J D Erickson,et al.  Racial and temporal variations in the prevalence of heart defects. , 2001, Pediatrics.

[33]  A. Scheuerle,et al.  Frequency of Prenatal Diagnosis of Birth Defects in Houston, Galveston and the Lower Rio Grande Valley, Texas 1995 , 2000, Fetal Diagnosis and Therapy.

[34]  N. Powe,et al.  Racial Differences in Access to the Kidney Transplant Waiting List for Children and Adolescents With End-Stage Renal Disease , 2000, Pediatrics.

[35]  Ronsaville Ds,et al.  Well child care in the United States : Racial differences in compliance with guidelines , 2000 .

[36]  E. Cook,et al.  The impact of managed care insurance on use of lower-mortality hospitals by children undergoing cardiac surgery in California. , 2000, Pediatrics.

[37]  R. Chang,et al.  Factors associated with age at operation for children with congenital heart disease. , 2000, Pediatrics.

[38]  H. Leonard,et al.  Survival of infants born with Down's syndrome: 1980-96. , 2000, Paediatric and perinatal epidemiology.

[39]  G. Shaw,et al.  The effect of congenital anomalies on mortality risk in white and black infants. , 1999, American journal of public health.

[40]  S. Goldberg,et al.  Factors influencing age at referral of children with congenital heart disease. , 1997, Archives of pediatrics & adolescent medicine.

[41]  J. Rouleau,et al.  Temporal Trends in Canadian Birth Defects Birth Prevalences, 1979–1993 , 1997, Canadian journal of public health = Revue canadienne de sante publique.

[42]  R. Califf,et al.  Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? , 1997, The New England journal of medicine.

[43]  C. Huether,et al.  Epidemiologic study of Down syndrome in a racially diverse California population, 1989-1991. , 1997, American journal of epidemiology.

[44]  J. P. Hughes,et al.  First year-of-life mortality among infants with oral clefts: New York State, 1983-1990. , 1996, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[45]  J. P. Hughes,et al.  Mortality among infants with congenital malformations, New York State, 1983 to 1988. , 1996, Public health reports.

[46]  J. Blustein,et al.  Access to hospitals with high-technology cardiac services: how is race important? , 1995, American journal of public health.

[47]  D. Fixler,et al.  Ethnicity and socioeconomic status: impact on the diagnosis of congenital heart disease. , 1993, Journal of the American College of Cardiology.

[48]  E L Hannan,et al.  Coronary Artery Bypass Surgery: The Relationship Between Inhospital Mortality Rate and Surgical Volume After Controlling For Clinical Risk Factors , 1991, Medical care.

[49]  J. Hoffman,et al.  Congenital heart disease: incidence and inheritance. , 1990, Pediatric clinics of North America.

[50]  K. Nielsen,et al.  Rates and survival of individuals with trisomy 13 and 18 Data from a 10‐year period in Denmark , 1988, Clinical genetics.

[51]  W. Nembhard,et al.  Racial/ethnic disparities in mortality related to congenital heart defects among children and adults in the United States. , 2008, Ethnicity & disease.

[52]  E. Howell.  Racial disparities in infant mortality: a quality of care perspective. , 2008, The Mount Sinai journal of medicine, New York.

[53]  T. To,et al.  Determinants of survival in children with congenital abnormalities: a long-term population-based cohort study. , 2006, Birth defects research. Part A, Clinical and molecular teratology.

[54]  M. Hillemeier,et al.  Widening Black/White mortality differentials among US children during the 1980s. , 2001, Ethnicity & disease.

[55]  R. Hakim,et al.  Well child care in the United States: racial differences in compliance with guidelines. , 2000, American journal of public health.