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Lesion-Specific Congenital Heart Disease Mortality Trends in Children: 1999 to 2017
Melodie M Lynn1,2, Jason L Salemi3,4, Stefan P Kostelyna2
1Division of Pediatric Cardiology.
Insights
Pediatric congenital heart disease (CHD) mortality is declining overall, but single ventricle lesions remain a major cause of death in children. Risk factors like prematurity worsen outcomes for infant CHD deaths.
Area of Science:
- Pediatric Cardiology
- Public Health
- Medical Statistics
Background:
- Congenital heart disease (CHD) is a primary cause of infant and child mortality.
- Data on lesion-specific mortality trends in pediatric CHD are limited.
- Understanding these trends is crucial for improving outcomes.
Purpose of the Study:
- To analyze pediatric mortality trends stratified by specific congenital heart disease lesions in the United States.
- To identify temporal changes in CHD mortality from 1999 to 2017.
- To examine the impact of contributing risk factors on CHD mortality.
Main Methods:
- Utilized 19-year (1999-2017) mortality data from the National Center for Health Statistics.
- Stratified analysis by CHD diagnosis and age groups (infants, 1-4 years, 5-17 years).
- Employed joinpoint regression to analyze temporal trends and risk factor effects.
Main Results:
- Infant mortality was highest across all CHD lesions, particularly for total anomalous pulmonary venous return.
- Most lesions showed significant declines in infant CHD mortality.
- Single ventricle lesions exhibited the highest mortality rates across all ages, with increasing rates in older children (5-17 years).
- Contributing factors like prematurity and genetic conditions were present in 19% of infant deaths and associated with worse trends.
Conclusions:
- Congenital heart disease mortality is decreasing for most lesions.
- Mortality trends vary significantly by lesion type and age group.
- Single ventricle lesions represent a persistent challenge, contributing significantly to premature death, especially in children aged 5-17 years.
Objective:
Congenital heart disease (CHD) is a leading cause of premature death in infants and children. Currently limited data are available regarding lesion specific mortality over time. Our study aimed to describe pediatric mortality trends by CHD lesion in the United States.
Methods:
We conducted a 19 year analysis (1999 to 2017) of publicly available, deidentified multiple cause of death data compiled and produced by the National Center for Health Statistics. Analysis was stratified by CHD diagnosis and age using 3 age categories (infants, 1 to 4 years, and 5 to 17 years). Temporal trends of CHD mortality and the effect of contributing risk factors were analyzed by using joinpoint regression.
Results:
Mortality was highest for in infants for all CHD lesions, in particular for total anomalous pulmonary venous return. Significant declines in infant CHD mortality occurred for most other lesions. Contributing risk factors, including prematurity, extracardiac birth defects, and genetic conditions, occurred in 19% of infant CHD deaths and demonstrated worse mortality trends in the majority of lesions. Mortality rates remained highest for single ventricle lesions in all ages, with an infant mortality rate plateau in the later half of the study and progressive increasing mortality rates for children 5 to 17 years.
Conclusions:
CHD mortality is decreasing for most lesions. Because of the heterogenicity of CHD lesions, there is expected variability in mortality trends by lesion and age group. Single ventricle lesions continue to contribute most heavily to premature death because of CHD demonstrated by significant increases in mortality rate for children aged 5 to 17 years.
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