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Survival and Risk Factors for Mortality in Infants With Congenital Heart Disease in South Korea
Jue Seong Lee1, Jeha Kwon2, Hannah Cho1
1Department of Pediatrics, Korea University Medical Center, Korea University College of Medicine, Seoul, Republic of Korea.
Insights
Infant survival with congenital heart disease (CHD) is high in South Korea, reaching 97.9%. Neonatal conditions like birth asphyxia significantly impact childhood mortality, highlighting the need for individualized risk assessment.
Area of Science:
- Pediatric Cardiology
- Public Health
- Neonatal Medicine
Background:
- Congenital heart disease (CHD) survival has improved globally.
- Disparities in CHD outcomes exist based on healthcare systems.
- South Korea has a robust healthcare system for CHD management.
Purpose of the Study:
- To analyze infant survival rates up to 18 years for congenital heart disease in South Korea.
- To identify neonatal risk factors influencing childhood mortality in CHD patients.
- To leverage large-scale population data for comprehensive analysis.
Main Methods:
- Retrospective analysis of Korean National Health Insurance Service claims data (2002-2020).
- Inclusion of infants diagnosed with CHD under one year of age.
- Hierarchical classification of CHD lesions and identification of neonatal risk factors.
Main Results:
- Overall childhood survival for infants with CHD was 97.9% (127,958 infants, 2,275 deaths).
- Highest mortality rates were linked to non-conotruncal (19.7%) and conotruncal (10.2%) defects.
- Significant mortality risk factors included complex CHD, pulmonary hypertension, birth asphyxia, and respiratory distress.
Conclusions:
- Infant survival with CHD is favorable in South Korea.
- Specific neonatal conditions are identified as critical risk factors for mortality.
- Personalized risk assessment and treatment strategies are crucial for improving CHD survival.
Background/Aim:
The survival of patients with congenital heart disease (CHD) has dramatically improved over recent decades. However, a disparity exists depending on the country and medical system. This study aimed to analyze the survival of infants with CHD until the age of 18 years using large-scale population data in South Korea and investigate the effect of neonatal conditions at birth.
Patients And Methods:
We retrospectively extracted the Korean National Health Insurance Service claims data from January 2002 to December 2020. We included patients diagnosed with CHD who were less than one year of age. The follow-up duration was until their death or until they were censored before the age of 18 years. The CHD lesions were classified hierarchically (conotruncal, severe non-conotruncal, coarctation of the aorta, ventricular septal defect, atrial septal defect, and others). Several neonatal conditions were adopted as risk factors.
Results:
Overall, 127,958 infants had been diagnosed with CHD and 2,275 died before the age of 18 years. The survival rate of infants with CHD during childhood was 97.9%. The highest childhood mortality rate was associated with non-conotruncal defects (19.7%), followed by conotruncal defects (10.2%). The significant risk factors for childhood mortality were complex CHD, pulmonary hypertension, birth asphyxia, small for gestational age, respiratory distress, pulmonary hemorrhage, bronchopulmonary dysplasia, and convulsions.
Conclusion:
The survival of infants with CHD has been favorable in South Korea. Several neonatal conditions are risk factors for childhood mortality. Individualized risk assessment and optimal treatment strategies may help improve their survival rate.
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