Survival among infants with congenital heart defects: Do communities matter?

Congenital heart defects (CHDs) are a leading cause of infant mortality and require access to specialized medical care. This study examined the association between survival of infants born with one of seven severe CHDs and indicators related to healthcare availability and area socioeconomic conditions. Infants born in 1999-2008 with selected CHDs were obtained from population-based, state-wide birth defects surveillance programs in Arizona, New Jersey, New York, and Texas. Vital status was obtained by matching birth defect cases to death certificates and/or hospital discharge files. Geocoded cases were linked to county-level healthcare availability and census tract-level socioeconomic indicators. Kaplan-Meier survival probabilities and Cox proportional hazards models were used to estimate infant mortality risk after adjustment for maternal and infant characteristics. In the four states, 9,853 infants were identified with at least one of the selected severe CHDs. The overall infant survival rate was 80.3%. Statistically significant increased neonatal mortality risk were found in areas with low concentration of general pediatricians (adjusted hazard ratio (aHR)=1.40, 95% confidence interval (CI), 1.04-1.89), low per capita income (aHR=1.30, 95% CI, 1.07-1.59), low education (HR=1.28, 95% CI, 1.05-1.56), and high proportion of labor occupations (aHR=1.33, 95% CI, 1.10-1.62). Non-Hispanic blacks and Hispanics had a 57% and 29% (p<0.05) increased post-neonatal mortality risk, respectively. One-year survival among infants born with select CHDs varied modestly by area-based measures of health care availability and socioeconomic status, suggesting that further efforts are needed to promote access for infants born with select CHDs in low resource settings.