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Published on: March 10, 2020
Association of social determinants with the severity of congenital heart disease
Mario J Forero-Manzano1,2,3, Eddy Triana-Palencia2, Jenny A Figueroa-Rueda2
1Neumología Pediátrica, Hospital Internacional de Colombia HIC - Instituto Cardiovascular, Fundación Cardiovascular de Colombia, Piedecuesta, Santander, Colombia.
Insights
Maternal exposure to cigarette and wood smoke, along with low socioeconomic status, are key social determinants linked to increased congenital heart disease severity in children. Public health policies should focus on reducing these exposures during pregnancy.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- Congenital heart diseases (CHDs) are the leading cause of mortality in newborns and infants.
- Understanding the social determinants of CHD severity is crucial for targeted interventions.
Purpose of the Study:
- To analyze social determinants associated with the severity of congenital heart disease in children.
- To identify risk factors within family environments impacting CHD outcomes.
Main Methods:
- An analytical cross-sectional study was conducted with 140 families of children diagnosed with CHD.
- A structured survey assessed family structure, health, economic conditions, and environmental exposures.
- Data was collected over a one-year period.
Main Results:
- Low socioeconomic status was prevalent in 53.7% of the studied population.
- Maternal exposure to cigarette and wood smoke during pregnancy was associated with increased CHD severity.
- Only 22% of CHDs were diagnosed prenatally, with 28.3% of mothers having fewer than four prenatal visits.
Conclusions:
- Maternal smoking, wood smoke exposure, and low socioeconomic status are significant social determinants of CHD severity.
- These factors are particularly relevant when analyzing disease by pathophysiological groups (cyanotic/non-cyanotic/single ventricle).
Background:
Congenital heart diseases are the most prevalent congenital malformations and cause greater morbi-mortality in newborns and infants. The aim of this study was to analyze the social determinants in families with children with the severity of congenital heart disease.
Methods:
Analytical cross-sectional study in 140 families of children with congenital heart disease to whom a structured survey was applied addressing topics related to family structure, health, economic conditions, exposure factors, and other social conditions relevant to the study, during 1 year.
Results:
In all, 53.7% of the studied population belonged to low socioeconomic levels. No association was found between the severity of the heart disease and the presence of pathological antecedents in the parents. The families resided in urban areas. Also, 28.3% of the mothers had four or fewer prenatal controls during pregnancy. Only 22% of heart diseases were diagnosed during pregnancy. It was found that exposure to cigarette and wood smoke during pregnancy, in addition to low socioeconomic status, was associated with greater severity of heart disease (RACHS-1 and STS-Score), when evaluated by pathophysiological groups (cyanotic/non-cyanotic/single ventricle).
Conclusions:
Exposure to cigarette smoke, wood smoke during pregnancy, and low socioeconomic status turned out to be social determinants associated with the severity of heart disease analyzed by pathophysiological groups.
Impact:
The social component has not been well characterized as a cause of congenital heart disease, especially in countries like ours, where the existence of gaps and social inequities have a high impact. The findings of this study could have an impact on public health to the extent that policies are implemented to reduce exposure to cigarettes, especially during pregnancy. Knowledge of these changes and their measurement in this type of pathology could open the door to the creation of policies aimed at their prevention, focusing on the local risk factors found, which can impact the disease.
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