Log in to MyACC
Socioeconomic, Geographic Factors and Prenatal Congenital Heart Disease Diagnosis
Quick Takes
- Lower socioeconomic quartile was associated with a lower rate of prenatal diagnosis of hypoplastic left heart syndrome and transposition of the great arteries (TGA).
- For TGA, Hispanic ethnicity and rural residence were also associated with a lower rate of prenatal diagnosis.
Study Questions:
What is the impact of sociodemographic and geographic factors on the prenatal diagnosis (PND) of infants with hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA)?
Methods:
A retrospective cohort study was performed at 21 centers in the United States and Canada. The study included fetuses and infants <2 months of age with HLHS or TGA admitted between 2012 and 2016 to participating Fetal Heart Society Research Collaborative institutions in the United States and Canada. Subjects were assigned a socioeconomic quartile (SEQ) z-score using the neighborhood summary score or Canadian Chan index and separated into quartiles. Associations among SEQ, insurance type, race and ethnicity, rural residence, and distance of residence with PND of HLHS and TGA were evaluated using bivariate analysis with adjusted associations for confounding variables and cluster analysis for centers.
Results:
Data were available for 1,862 subjects, of which 1,171 had HLHS and 691 had TGA. PND occurred in 92% of patients with HLHS and 58% of patients with TGA. In the United States, lower SEQ was associated with lower PND in both HLHS and TGA, with the strongest association in the lower SEQ of pregnancies with fetal TGA (quartile 1, 0.78; quartile 2, 0.77; quartile 3, 0.83; quartile 4, reference). Hispanic ethnicity (relative risk, 0.85) and rural residence (relative risk, 0.78) were also associated with lower PND in TGA.
Conclusions:
The authors concluded that lower SEQ, Hispanic ethnicity, and rural residence are associated with decreased prenatal diagnosis for TGA, with lower SEQ also being associated with decreased prenatal diagnosis for HLHS.
Perspective:
PND of certain complex congenital heart defects has been shown to be associated with decreased neonatal morbidity and mortality. This study assesses the impact of demographic and socioeconomic factors on two common congenital heart lesions, HLHS and TGA. Successful PND of congenital heart disease requires both access to care for patients as well as skilled interpretation of prenatal imaging. Historically, rates of diagnosis of HLHS have been higher than that for TGA in part because diagnosis of TGA requires assessment beyond the standard four-chamber view. This study demonstrated rates of diagnosis across the entire cohort to be 92% for HLHS and 58% for TGA. The identification of socioeconomic, demographic, and geographic risk factors for failure of PND is a useful first step in focusing on education related to congenital heart disease detection and integration of systems of care to minimize these disparities.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Quality Improvement
Keywords: Diagnostic Imaging, Ethnic Groups, Heart Rate, Fetal, Health Services Accessibility, Heart Defects, Congenital, Hispanic Americans, Hypoplastic Left Heart Syndrome, Infant, Infant, Newborn, Pregnancy, Prenatal Diagnosis, Primary Prevention, Rural Health, Socioeconomic Factors, Transposition of Great Vessels, Women
< Back to Listings
