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. 2014 Nov;104(11):e150-7.
doi: 10.2105/AJPH.2014.302099. Epub 2014 Sep 11.

Community socioeconomic disadvantage and the survival of infants with congenital heart defects

James E Kucik  1 , Wendy N Nembhard, Pamela Donohue, Owen Devine, Ying Wang, Cynthia S Minkovitz, Thomas Burke
Affiliations

Community socioeconomic disadvantage and the survival of infants with congenital heart defects

James E Kucik et al. Am J Public Health. 2014 Nov.

Abstract

Objectives: We examined the association between survival of infants with severe congenital heart defects (CHDs) and community-level indicators of socioeconomic status.

Methods: We identified infants born to residents of Arizona, New Jersey, New York, and Texas between 1999 and 2007 with selected CHDs from 4 population-based, statewide birth defect surveillance programs. We linked data to the 2000 US Census to obtain 11 census tract-level socioeconomic indicators. We estimated survival probabilities and hazard ratios adjusted for individual characteristics.

Results: We observed differences in infant survival for 8 community socioeconomic indicators (P < .05). The greatest mortality risk was associated with residing in communities in the most disadvantaged deciles for poverty (adjusted hazard ratio [AHR] = 1.49; 95% confidence interval [CI] = 1.11, 1.99), education (AHR = 1.51; 95% CI = 1.16, 1.96), and operator or laborer occupations (AHR = 1.54; 95% CI = 1.16, 1.96). Survival decreased with increasing numbers of indicators that were in the most disadvantaged decile. Community-level mortality risk persisted when we adjusted for individual-level characteristics.

Conclusions: The increased mortality risk among infants with CHDs living in socioeconomically deprived communities might indicate barriers to quality and timely care at which public health interventions might be targeted.

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Figures

FIGURE 1—
FIGURE 1—
One-year survival probabilities for infants born with congenital heart defect, by number of census tract–level indicators (n = 11) of socioeconomic status (SES) in the most disadvantaged decile: Arizona, New Jersey, New York, and Texas birth defects surveillance programs, 1999–2007.
FIGURE 2—
FIGURE 2—
Interaction between census tract–level and individual-level variables on 1-year survival of infants with congenital heart defect by (a) education level and (b) ethnicity: Arizona, New Jersey, New York, and Texas birth defect surveillance programs, 1999–2007. Note. Individual-level variables are level of education and ethnicity. Census tract–level variables are most and least advantages deciles.
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