We examined the role of neighborhood-level socioeconomic position (nSEP) in 1- and 5-year survival among children with critical congenital heart defects (CCHDs). Children with CCHDs in the National Birth Defects Prevention Study (1999-2011) were grouped into univentricular and biventricular defects and linked to vital records for 1- and 5-year mortality. The Neighborhood Deprivation Index (NDI) was used to classify census-tract nSEP (low [referent], moderate, high deprivation) using maternal periconceptional address. Kaplan-Meier survival curves and log-rank tests were used to evaluate survival differences. Cox proportional hazards regression models were used to estimate crude and adjusted hazard ratios and 95% confidence intervals, adjusting for birth years, maternal sociodemographic factors, and residential mobility. Among 2459 children with CCHDs, 1 year survival curves differed by neighborhood deprivation. Survival was lowest among children of mothers living in high- vs low-deprivation neighborhoods. In crude analyses, high deprivation was associated with higher 1-year mortality (all CCHDs: 1.58 [1.17, 2.13]; univentricular CCHDs: 1.50 [0.99, 2.26]; biventricular CCHDs: 1.64 [1.02, 2.64]). After adjustment, estimates were generally attenuated and less precise. Five-year survival showed similar trends. Further research could inform strategies to address the structural, environmental, and/or physiological factors associated with a potential reduced survival among children with CCHDs born to mothers in socioeconomically deprived areas.
Keywords: CCHD severity; critical congenital heart defects; early childhood mortality; infant mortality; neighborhood deprivation; socioeconomic disparity; survival analysis.
Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2026. This work is written by (a) US Government employee(s) and is in the public domain in the US.