Ethnicity and socioeconomic status: Impact on the diagnosis of congenital heart disease

Fixler, David E; Pastor, Patricia; Sigman, Ellen S.; Eifler, Clayton W.

doi:10.1016/0735-1097(93)90393-f

Cited by 63 publications

(47 citation statements)

References 11 publications

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“…The lower prevalence of coarctation of the aorta for NH-black and Hispanic infants compared with NH-white infants suggested in the literature 9,20,29 is seen in our data to occur only among Hispanic males and females compared with NH-whites and although present for both black males and females, not statistically significant. Although reports of lower prevalence of ventricular septal defect for NH-blacks and Hispanics compared with NH-whites 14 was also seen in our study, the magnitude of the decrease was similar for both male and female NH-black and Hispanic infants compared with NH-whites. Our finding of lower prevalence of atrioventricular septal defect for Hispanic females compared with NH-white females has not been previously reported.…”

Section: Original Articlessupporting

confidence: 62%

“…It is also possible that our results are due to racial/ethnic-sex differences in diagnosis of CHD after birth, but no published studies have documented differential access to diagnosis or care for infants with CHD. Although studies show racial/ethnic disparities in access to pediatric care and treatment received when care is obtained, [33][34][35] there are no statistically significant differences between blacks and whites in the age at diagnosis of CHD 36 and no reason to believe that, if present, this would occur differentially by sex; however, differential access to care could explain observed differences within sex groups.…”

Section: Original Articlesmentioning

confidence: 99%

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Variation in the Prevalence of Congenital Heart Defects by Maternal Race/Ethnicity and Infant Sex

Nembhard

Wang

Loscalzo

et al. 2010

The Journal of Pediatrics

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Objective To determine the prevalence of major congenital heart defects (CHD) by ethnicity and sex. Study design Data from the Florida Birth Defects Registry was used to conduct a retrospective cohort study with 8029 singleton infants with 11 CHDs born 1998-2003 to resident non-Hispanic (NH) white, NH-black, and Hispanic women aged 15 to 49. Defect-specific prevalence rates, ratios, and 95% confidence intervals were calculated. Poisson regression was used to calculate adjusted ethnic-specific rate ratios (RR) for each CHD. Statistical significance was P < .0001.Results Compared with NH-whites, NH-black males had significantly increased rates of pulmonary valve atresia/ stenosis (RR = 1.66) but lower prevalence of aortic valve atresia/stenosis (RR = 0.33) and ventricular septal defect (VSD; RR = 0.78). Hispanic males had lower rates of aortic valve atresia/stenosis (RR = 0.28), coarctation of the aorta (RR = 0.61) and VSD (RR = 0.79). NH-black females had statistically significantly lower rates of VSD (RR = 0.75), and Hispanic females had lower rates of tetralogy of Fallot (RR = 0.54), VSD (RR = 0.84) and atrioventricular septal defects (RR = 0.53) compared with NH-whites.Conclusions We found differences in ethnic susceptibilities to CHD by sex, but the cause remains unclear. (J Pediatr 2010;156:259-64).

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Section: Original Articlessupporting

confidence: 62%

Section: Original Articlesmentioning

confidence: 99%

Variation in the Prevalence of Congenital Heart Defects by Maternal Race/Ethnicity and Infant Sex

Nembhard

Wang

Loscalzo

et al. 2010

The Journal of Pediatrics

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“…Previously published studies reported no racial/ ethnic differences in age at referral to pediatric cardiology practices. 26,27 Of note in the current study, racial/ethnic disparities in neonatal mortality were 40% higher in NH-blacks and 26% higher in Hispanics compared with NH-whites. Race/ethnic differences in mortality could be due to variations in morphologic severity of the defect being greater among minorities, but to our knowledge, no studies have described such differences.…”

Section: Resultsmentioning

confidence: 93%

Age at Referral and Mortality From Critical Congenital Heart Disease

Fixler

Nembhard

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Newborn pulse oximetry screening is recommended to promote early referral of neonates with critical congenital heart disease (CCHD) and reduce mortality; however, the impact of late referral on mortality is not well defined. The purpose of this population-based study was to describe the association between timing of referral to a cardiac center and mortality in 2360 liveborn neonates with CCHD. METHODS: Neonates with CCHD born before pulse oximetry screening (1996–2007) were selected from the Texas Birth Defects Registry and linked to state birth and death records. Age at referral was ascertained from date of first cardiac procedure at a cardiac center. Logistic and Cox proportional hazards regression models were used to estimate factors associated with late referral and mortality; the Kaplan-Meier method was used to estimate 3-month survival. RESULTS: Median age at referral was 1 day (25th–75th percentile: 0–6 days). Overall, 27.5% (649 of 2360) were referred after age 4 days and 7.5% (178 of 2360) had no record of referral. Neonatal mortality was 18.1% (277 of 1533) for those referred at 0 to 4 days of age, 9.0% (34 of 379) for those referred at 5 to 27 days of age, and 38.8% (69 of 178) for those with no referral. No improvement in age at referral was found across the 2 eras within 1996–2007. CONCLUSIONS: A significant proportion of neonates with CCHD experienced late or no referral to cardiac specialty centers, accounting for a significant number of the deaths. Future population-based studies are needed to determine the benefit of pulse oximetry screening on mortality and morbidity.

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“…It has been proposed that racial disparities in mortality may be due to differences in access to medical care. In a population-based study of congenital heart disease patients born in Dallas County, Texas, in 1971 to 1984, Fixler et al 20 reported that the timing of referral for pediatric cardiac care was not related to ethnicity, median family income, or household education. Chang et al, 21 using data from hospital discharges for 1995 to 1996 in California, found no difference between whites, blacks, and Asians in age at operation for congenital heart disease.…”

Section: Fixler Et Al Five-year Mortality Of Functional Single Ventriclementioning

confidence: 99%

Mortality in First 5 Years in Infants With Functional Single Ventricle Born in Texas, 1996 to 2003

et al. 2010

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Ethnicity and socioeconomic status: Impact on the diagnosis of congenital heart disease

Cited by 63 publications

References 11 publications

Variation in the Prevalence of Congenital Heart Defects by Maternal Race/Ethnicity and Infant Sex

Variation in the Prevalence of Congenital Heart Defects by Maternal Race/Ethnicity and Infant Sex

Age at Referral and Mortality From Critical Congenital Heart Disease

Mortality in First 5 Years in Infants With Functional Single Ventricle Born in Texas, 1996 to 2003

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