Maternal race/ethnicity and survival experience of children with congenital heart disease

Abstract

Objective: To investigate the existence of racial/ethnic disparity in mortality risk among children with individual congenital heart defects and identify any other risk factors.

Study design: The study cohort, comprising children born between 1983 and 2006 with a selected congenital heart defect, was matched to death records to ascertain vital status. The birth and maternal risk factors were obtained from birth certificates.

Results: After adjusting for covariates using a multivariate regression model, the risk of mortality was significantly higher in children of non-Hispanic black mothers with transposition of the great arteries (hazard ratio (HR), 1.31; 95% CI, 1.07-1.60), tetralogy of Fallot (HR, 1.34; 95% CI, 1.06-1.69), and coarctation of the aorta (HR, 1.40; 95% CI, 1.10-1.79), compared with children of non-Hispanic white mothers. Time trends analysis examining the mortality risk by survival age and birth period found a significant decrease in 5-year mortality risk from 1983 to 2003 births, with a nearly 50% reduction for hypoplastic left heart syndrome and coarctation of the aorta across 3 maternal racial/ethnic groups examined.

Conclusion: Our findings may help identify at-risk populations and mortality risk factors and thereby contribute to improved survival and quality of life for these children across the lifespan.

Keywords: CA; CHD; CMR; Coarctation of the aorta; Congenital Malformations Registry; Congenital heart defect; HLHS; HR; Hazard ratio; Hypoplastic left heart syndrome; ICD-9-CM; International Classification of Diseases, Ninth Revision, Clinical Modification; NH; Non-Hispanic; TGA; TOF; Tetralogy of Fallot; Transposition of the great arteries; VSD; Ventricular septal defect.