Social Determinants of Health Linked to Congenital Heart Disease

May 19, 2021 - Social determinants of health, including geography and race and ethnicity, have an impact on prenatal detection (PND) of two of the most common congenital heart diseases (CHDs), a new study published in the American Heart Association’s Circulation journal reveals.

Prenatal detection or diagnosis of congenital heart diseases like hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGS) have significant impacts on health outcomes. Clinicians can intervene earlier, often leading to lower pre and postoperative mortality and a shorter stay in the hospital, the study stated.

“PND is thought to be associated with improved longer-term outcomes, including better neurodevelopmental outcomes, improvements in postnatal brain maturation, and decreased risk of postnatal brain injury,” the study explained.

According to the Centers for Disease Control and Prevention (CDC) website, one in every 3,841 babies born in the US have HLHS, and one in every 3,413 have TGA. Both HLHS and TGA are critical congenital heart diseases, meaning that patients will need surgery or other medical procedures within one year of birth, the CDC states.

Researchers studied a cohort from 21 North American cardiology centers, with the goal of determining whether socioeconomic and geographic factors were correlated with lower rates of prenatal detection of HLHS and TGS. The study consisted of both prenatally diagnosed fetuses and postnatally diagnosed infants with HLHS or TGA. There were 1862 patients total. The secondary goal was to compare social determinants of health between the US and Canada due to their differing health care systems.

The independent variables analyzed included neighborhood socioeconomic quartile (SEQ), rural residence, neighborhood poverty rates, neighborhood race and ethnicity distribution, driving distance and time to a cardiac surgical center, and at-risk geographic location, along with maternal insurance, race and ethnicity.

“In unadjusted analyses evaluating the entire cohort, socioeconomic variables associated with a lack of PND were lower SEQ, rural address, further distance in miles or time to a care center, and public insurance,” the study stated.

“Younger maternal age was also associated with lack of PND, as was singleton pregnancy compared with multiple-gestation pregnancy.”

Despite the presence of universalized healthcare in Canada, the study concluded that prenatal detection rates were very similar between Canada and the US, at least based on the small subset of patients evaluated.

Study results showed significant associations between rates of prenatal detection of HLHS and TGA and social determinants of health. Specifically, lower SEQ, rural residence, and Hispanic ethnicity were linked to lower prenatal detection rates. In Canada, only a further distance to a cardiac surgical center was correlated with lower rates prenatal detection.

Rural health care disparities have been highlighted by various health and government organizations recently. In April, CMS proposed a $2.5 billion increase in Medicare hospital inpatient rates in the next fiscal year, along with an increased focus on rural health care and health equity. In addition, HHS recently announced it is distributing nearly $1 billion from the Biden administration’s American Rescue Plan to rural health providers for COVID-19 relief. Access to care in rural areas appears to lead to worse health outcomes.

“Lower socioeconomic status may have less of an effect on PND in socialized health care systems, such as are available in Canada, however distance of residence may still remain a source of inadequate access to prenatal screening, and mothers with lower SEQ still received a later PND than those with higher SEQs,” the study said.

“Efforts surrounding education about CHD detection, as well as improving linkages between the tertiary care surgical centers and primary care physicians, may increase these disparities.”