Clinical and socio-economic predictors of work participation in adult CHD patients

Abstract

<jats:title>Abstract</jats:title> <jats:sec id="S1047951120001572_as1" sec-type="other"> <jats:title>Background:</jats:title> <jats:p>Adults with CHD have reduced work participation rates compared to adults without CHD. We aimed to quantify employment rate among adult CHD patients in a population-based registry and to describe factors and barriers associated with work participation.</jats:p> </jats:sec> <jats:sec id="S1047951120001572_as2" sec-type="other"> <jats:title>Methods:</jats:title> <jats:p>We retrospectively identified adults with employment information in the North Carolina Congenital Heart Defects Surveillance Network. Employment was defined as any paid work in a given year. Logistic regression was used to examine patients’ employment status during each year.</jats:p> </jats:sec> <jats:sec id="S1047951120001572_as3" sec-type="other"> <jats:title>Results:</jats:title> <jats:p>The registry included 1,208 adult CHD patients with a health care encounter between 2009 and 2013, of whom 1,078 had ≥1 year of data with known employment status. Overall, 401 patients (37%) were employed in their most recent registry year. On multivariable analysis, the odds of employment decreased with older age and were lower for Black as compared to White patients (odds ratio = 0.78; 95% confidence interval: 0.62, 0.98; p = 0.030), and single as compared to married patients (odds ratio = 0.50; 95% confidence interval: 0.39, 0.63; p &lt; 0.001).</jats:p> </jats:sec> <jats:sec id="S1047951120001572_as4" sec-type="other"> <jats:title>Conclusion:</jats:title> <jats:p>In a registry where employment status was routinely captured, only 37% of adult CHD patients aged 18–64 years were employed, with older patients, Black patients, and single patients being less likely to be employed. Further work is needed to consider how enhancing cardiology follow-up for adults with CHD can integrate support for employment.</jats:p> </jats:sec>

Advances in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: A Practical Approach to Transition Program Design: A Scientific Statement From the American Heart Association

“…There is recent evidence suggesting that adults with congenital heart disease have high rates of unemployment, particularly among Black individuals. 18 , 19 Given that education is closely linked with employment, access to insurance, and income, the potential disadvantages experienced by survivors of congenital heart disease must be acknowledged. Establishing programs that screen for the contributions of SDOH and mitigate opportunity costs, provide formal transition education (including skills and training on navigating the medical/insurance systems), and emphasize patient/parent education about the need for maintenance of long‐term care, are necessary for minimizing barriers to care during the transition period.…”

Transitioning Adolescents and Young Adults With Congenital Heart Disease to Adult-Centered Care

“…Survivors of CHD, particularly those with complex lesions, are at risk for cognitive deficits and emotional distress with a potential to impact educational attainment and opportunities for employment 8 . Relatedly, there is recent evidence suggesting that adults with CHD have high rates of unemployment, particularly among Black individuals 9 . John and colleagues 3 (2022) suggest that establishing programs that screen for social determinants of health, mitigate opportunity costs, and provide transition education and training on navigating the medical and insurance systems are important considerations designed to improve and optimize care during transition.…”

“…8 Relatedly, there is recent evidence suggesting that adults with CHD have high rates of unemployment, particularly among Black individuals. 9 John and colleagues 3 (2022) suggest that establishing programs that screen for social determinants of health, mitigate opportunity costs, and provide transition education and training on navigating the medical and insurance systems are important considerations designed to improve and optimize care during transition. In addition, emphasis in such programs should be placed on patient and parent/provider education regarding the need for and benefits of long-term care for patients with CHD.…”