Related Experiment Video
Updated: Jul 23, 2025
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Disparities in 1-Year-Mortality in Infants With Cyanotic Congenital Heart Disease: Insights From Contemporary
Martina A Steurer1,2, Charles McCulloch2, Stephanie Santana3
1Department of Pediatrics (M.A.S., S.P.), University of California San Francisco.
Insights
Socioeconomic factors, particularly maternal education, significantly explain racial disparities in congenital heart disease (CHD) infant mortality. Addressing these social determinants can help reduce inequities in CHD outcomes.
Area of Science:
- Public Health
- Pediatrics
- Health Disparities
Background:
- Racial inequities in congenital heart disease (CHD) outcomes are documented.
- Contributing factors to these disparities require further investigation.
- This study examines the interplay of race, socioeconomic position, and neonatal variables on infant mortality in CHD.
Purpose of the Study:
- To investigate the mediating role of socioeconomic position in racial disparities in 1-year mortality among infants with CHD.
- To quantify the contribution of socioeconomic factors to observed racial differences in CHD outcomes.
Main Methods:
- Utilized linked birth/death files from the US Natality database (2014-2018).
- Identified infants with cyanotic CHD and compared Non-Hispanic Black (NHB) and Hispanic infants to Non-Hispanic White (NHW) infants.
- Employed structural equation modeling to assess the mediation effects of socioeconomic position (maternal education, insurance status) and neonatal variables (prematurity, small for gestational age) on 1-year mortality.
Main Results:
- NHB and Hispanic infants with CHD had higher 1-year mortality rates compared to NHW infants.
- Socioeconomic position explained 28.2% of the mortality disparity between NHB and NHW, and 100% between Hispanic and NHW infants.
- Lower maternal education was a primary driver of these disparities, while insurance status alone was not significant. The direct effect of race/ethnicity on mortality became nonsignificant after accounting for mediators.
Conclusions:
- Lower socioeconomic position, especially reduced maternal education, substantially accounts for racial disparities in 1-year mortality for infants with CHD.
- These findings highlight social interventions targeting socioeconomic factors as crucial for reducing racial inequities in CHD outcomes.
- The study underscores the importance of addressing social determinants of health to improve pediatric cardiovascular health equity.
Background:
Racial inequities in congenital heart disease (CHD) outcomes are well documented, but contributing factors warrant further investigation. We examined the interplay between race, socioeconomic position, and neonatal variables (prematurity and small for gestational age) on 1-year death in infants with CHD. We hypothesize that socioeconomic position mediates a significant part of observed racial disparities in CHD outcomes.
Methods:
Linked birth/death files from the Natality database for all liveborn neonates in the United States were examined from 2014 to 2018. Infants with cyanotic CHD were identified. Non-Hispanic Black (NHB) and Hispanic infants were compared with non-Hispanic White (NHW) infants. The primary outcome was 1-year death. Socioeconomic position was defined as maternal education and insurance status. Variables included as mediators were prematurity, small for gestational age, and socioeconomic position. Structural equation modeling was used to calculate the contribution of each mediator to the disparity in 1-year death.
Results:
We identified 7167 NHW, 1393 NHB, and 1920 Hispanic infants with cyanotic CHD. NHB race and Hispanic ethnicity were associated with increased 1-year death compared to NHW (OR, 1.43 [95% CI, 1.25-1.64] and 1.17 [95% CI, 1.03-1.33], respectively). The effect of socioeconomic position explained 28.2% (CI, 15.1-54.8) of the death disparity between NHB and NHW race and 100% (CI, 42.0-368) of the disparity between Hispanic and NHW. This was mainly driven by maternal education (21.3% [CI, 12.1-43.3] and 82.8% [CI, 33.1-317.8], respectively) while insurance status alone did not explain a significant percentage. The direct effect of race or ethnicity became nonsignificant: NHB versus NHW 43.1% (CI, -0.3 to 63.6) and Hispanic versus NHW -19.0% (CI, -329.4 to 45.3).
Conclusions:
Less privileged socioeconomic position, especially lower maternal education, explains a large portion of the 1-year death disparity in Black and Hispanic infants with CHD. These findings identify targets for social interventions to decrease racial disparities.
