Ethnic and socioeconomic variation in incidence of congenital heart defects

Abstract

Introduction: Ethnic differences in the birth prevalence of congenital heart defects (CHDs) have been reported; however, studies of the contemporary UK population are lacking. We investigated ethnic variations in incidence of serious CHDs requiring cardiac intervention before 1 year of age.

Methods: All infants who had a cardiac intervention in England and Wales between 1 January 2005 and 31 December 2010 were identified in the national congenital heart disease surgical audit and matched with paediatric intensive care admission records to create linked individual child records. Agreement in reporting of ethnic group by each audit was evaluated. For infants born 1 January 2006 to 31 December 2009, we calculated incidence rate ratios (IRRs) for CHDs by ethnicity and investigated age at intervention, antenatal diagnosis and area deprivation.

Results: We identified 5350 infants (2940 (55.0%) boys). Overall CHD incidence was significantly higher in Asian and Black ethnic groups compared with the White reference population (incidence rate ratios (IRR) (95% CIs): Asian 1.5 (1.4 to 1.7); Black 1.4 (1.3 to 1.6)); incidence of specific CHDs varied by ethnicity. No significant differences in age at intervention or antenatal diagnosis rates were identified but affected children from non-White ethnic groups were more likely to be living in deprived areas than White children.

Conclusions: Significant ethnic variations exist in the incidence of CHDs, including for specific defects with high infant mortality. It is essential that healthcare provision mitigates ethnic disparity, including through timely identification of CHDs at screening, supporting parental choice and effective interventions. Future research should explore the factors underlying ethnic variation and impact on longer-term outcomes.

Keywords: Epidemiology; congenital heart disease; ethnicity; record linkage; socio-economic deprivation.

Figure 1

Distribution of cases by ethnic group and deprivation quintile (n=4860). Notes: *Excludes 218 children whose ethnic group was not recorded (from Quintile [Q] 1=52, Q2=46, Q3=37, Q4=30, Q5=37, Quintile not known=16) and 272 additional children whose area deprivation score was not recorded (White=250, Asian/Black/Other=22).

Figure 2

Incidence rate ratios of infants undergoing a cardiac intervention in England and Wales during 2006–2009 by ethnic group (n=5132). Notes: *Excluding 218 children with no ethnicity record; binomial exact method used to estimate confidence intervals for incidence rate ratios (IRR); reference category: White; cardiac intervention includes surgical and interventional catheter procedures.