Environmental and Socioeconomic Factors Influence the Live‐Born Incidence of Congenital Heart Disease: A Population‐Based Study in California

Abstract

BACKGROUND The development of congenital heart disease ( CHD ) is multifactorial with genetic and environmental influences. We sought to determine the relationship between socioeconomic and environmental factors with the incidence of CHD among live‐born infants in California and to determine whether maternal comorbidities are in the causal pathway. METHODS AND RESULTS This was a population‐based cohort study in California (2007–2012). The primary outcome was having significant CHD . Predictors included socioeconomic status and environmental exposure to pollutants determined by U.S. Census data. A social deprivation index and environmental exposure index was assigned based on neighborhood socioeconomic variables, categorized into 4 quartiles. Quartile 1 was the best with the least exposure to pollutants and social deprivation, and quartile 4 was the worst. Multivariate logistic regression and mediation analyses were performed. Among 2 419 651 live‐born infants, the incidence of CHD was 3.2 per 1000 live births. The incidence of CHD was significantly higher among those in quartile 4 compared with quartile 1 (social deprivation index: 0.35% versus 0.29%; odds ratio [OR], 1.31; 95% CI, 1.21–1.41; environmental exposure index: 0.35% versus 0.29%; OR, 1.23; 95% CI, 1.15–1.31) after adjusting for maternal race/ethnicity and age and accounting for the relationship between the 2 primary predictors. Maternal comorbidities explained 13% (95% CI, 10%–20%) of the relationship between social deprivation index and environmental exposure index with the incidence of CHD . CONCLUSIONS Increased social deprivation and exposure to environmental pollutants are associated with the incidence of live‐born CHD in California. Maternal comorbidities explain some, but not all, of this relationship. These findings identify targets for social policy initiatives to minimize health disparities.

Factors Associated with Congenital Heart Diseases among Children in Uganda: A Case-Control Study at Mulago National Referral Hospital (Uganda Heart Institute)

“…This inconsistencies might suggest that education might not be a suitable measure of socio-economic status in Ugandan setting. However our findings are consistent with results of a meta-analysis which found a no association between maternal socio-economic status, (measured using education level) and CHD among children [29] and those of a Cohort study conducted in California (US) that found an association between social deprivation and increased risk of CHD among children, to which authors attributed to environmental exposure of deprived communities to pollutants [30].…”

Di-2-ethylhexyl phthalate induces heart looping disorders during zebrafish development

“…However, CHD remains a leading cause of birth defect-related death and leaves its survivors at high risk with a range of related morbidities (Razzaghi et al, 2015). Growing evidence implies that endocrine-disrupting environmental contaminants are associated with high prevalence of birth defects (Peyvandi et al, 2020). Maternal exposure to organochlorines was linked to neural tube defects in fetuses (Kalra et al, 2016), and seasonal trends in hypospadias prevalence support a link between urogenital abnormalities and endocrine disruptors (Mamoulakis et al, 2017).…”

Global Burden of Congenital Heart Disease: Experience in Korea as a Potential Solution to the Problem

“…1) The incidence of 'significant CHD', which will require surgery before one year of age, was reported to be 3.2/1,000 live births in a population based study in North America. 2) A worldwide annual birth rate is around 150 million, which corresponds to 1.35 million live births with CHD and 480,000 births with significant CHDs every year. 2)3) In 2017, 5.4 million children under 5 years of age died worldwide, of whom 214,214 children with CHD died, representing 3.97% of all causes of death and 31.5 deaths per 100,000 poplulation.…”

“… 1) The incidence of ‘significant CHD’, which will require surgery before one year of age, was reported to be 3.2/1,000 live births in a population based study in North America. 2) A worldwide annual birth rate is around 150 million, which corresponds to 1.35 million live births with CHD and 480,000 births with significant CHDs every year. 2) 3) …”

“… 2) A worldwide annual birth rate is around 150 million, which corresponds to 1.35 million live births with CHD and 480,000 births with significant CHDs every year. 2) 3) …”