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Trends in congenital heart disease in Dallas County births. 1971-1984
D E Fixler1, P Pastor, M Chamberlin
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235.
Insights
Congenital heart disease prevalence increased due to better detection of mild cases, not more severe conditions. Rates varied by race, with whites having higher prevalence but similar severe case rates across groups.
Area of Science:
- Pediatric Cardiology
- Public Health
- Epidemiology
Background:
- Congenital heart disease (CHD) is a significant concern in pediatric health.
- Understanding prevalence and severity trends is crucial for public health initiatives.
Purpose of the Study:
- To analyze changes in birth cohort prevalence and severity of CHD.
- To compare CHD rates among Black, White, and Mexican-American infants.
Main Methods:
- Retrospective cohort study of liveborn infants in Dallas County (1971-1984).
- Diagnosis confirmed by clinical evaluation, echocardiography, catheterization, surgery, or autopsy.
- Prevalence rates calculated per 1,000 live births.
Main Results:
- Overall CHD prevalence was 6.6/1000 live births.
- White infants had higher prevalence (7.2/1000) than Black (5.6/1000) or Mexican-American (5.9/1000) infants.
- Severe CHD rates (3.1/1000) were similar across all racial groups; mild cases drove the apparent prevalence increase.
Conclusions:
- The apparent rise in CHD prevalence during the 1970s is attributed to increased detection of milder forms.
- No significant difference in severe CHD rates was observed among racial groups.
- Increased referrals of asymptomatic children with murmurs may explain the trend.
Abstract:
To examine the changes in birth cohort prevalence rates and severity of congenital heart disease, we studied children with congenital heart disease born to blacks, whites, and Mexican-Americans in Dallas County from 1971 through 1984. Diagnoses were made by pediatric cardiologists' clinical evaluations, echocardiography, catheterization, surgery, or autopsy. During this study period, 2,509 of 379,561 liveborn infants were diagnosed, a prevalence rate of 6.6/1000. The rates for whites was significantly higher than for blacks or Mexican-Americans--7.2/1,000, 5.6/1,000, and 5.9/1,000, respectively. The rate for severe cases requiring cardiac catheterization or surgery or undergoing autopsy was 3.1/1,000 and did not differ among the three groups. The time trend for rates of congenital heart disease suggested an apparent increase in prevalence rate during the 1970s; however, the prevalence rate of severe forms remained relatively stable. This indicates that the apparent rise in prevalence could be accounted for by an increase in detection of mild cases. These findings were interpreted as reflecting a greater tendency for pediatricians to refer asymptomatic children with significant heart murmurs to a pediatric cardiologist.