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Racial/Ethnic Disparities in Congenital Heart Disease Mortality
Quick Takes
- Overall mortality due to congenital heart disease in the United States declined between 1999 and 2017. The highest mortality rate occurs in infants <1 year of age.
- Disparities in mortality occurred, with mortality rates greater in men as compared with women, and in non-Hispanic blacks as compared with non-Hispanic whites.
Study Questions:
What are the current trends in US mortality related to congenital heart disease (CHD) from infancy to adulthood, and are there differences based on sex and race/ethnicity?
Methods:
An analysis of death certificates from 1999-2017 was conducted. Annual CHD mortality was calculated by age at death, race/ethnicity, and sex. National Center for Health Statistics live birth data were used to determine the denominators for mortality rate calculations for infants <1 year of age. For individuals ≥1 year of age, US Census Bureau bridged-race estimates were used. Temporal trends in all-cause mortality, mortality resulting directly due to and related to CHD by age, race/ethnicity, and sex were characterized using joinpoint regression.
Results:
There were 58,599 deaths attributable to CHD during the study period, out of a total of 47.7 million (1 in 814). All-cause mortality decreased 16.4% across all ages during the study period, while mortality resulting from CHD declined 39.4%. The age-adjusted mortality rate decreased from 1.37 to 0.83 per 100,000. Males had a higher mortality due to CHD than females. Mortality resulting from CHD significantly declined among all races/ethnicities studied. Disparities persisted for non-Hispanic blacks versus non-Hispanic whites (mean annual decreased 2.3% vs. 2.6%, respectively; age-adjusted mortality rate 1.67-1.05 vs. 1.35-0.80 per 100,000, respectively).
Conclusions:
The authors concluded that while overall mortality in the United States for patients with congenital heart disease has decreased over the last 19 years, disparities in mortality persist.
Perspective:
This population-based study assessed mortality rates for patients of all ages with congenital heart disease. There has been a steady decline in mortality rates over the last 19 years. The study highlights disparities in outcomes, with males at higher risk. The cause of this is not entirely clear. Certainly, there are some complex congenital lesions that are more common in males, which could contribute to this finding. Similar to other conditions, significant disparities are seen between non-Hispanic whites and non-Hispanic blacks. It will be important to understand the causes for these disparities, which may include impaired access to care, timely diagnosis, and insurance coverage such that the outcomes for these patients can be optimized in the long run.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Prevention, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Quality Improvement
Keywords: African Americans, Child Mortality, Ethnic Groups, Healthcare Disparities, Health Services Accessibility, Heart Defects, Congenital, Infant, Insurance Coverage, Live Birth, Longevity, Outcome Assessment, Health Care, Secondary Prevention
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