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Updated: Jun 15, 2025
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Socioeconomic Status and Access to Care for Pediatric and Adult Congenital Heart Disease in Universal Health Coverage
Amanda A Greenwell1, Mimi X Deng2,3, Shelagh Ross4
1Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
Insights
Congenital heart disease (CHD) care access varies significantly by socioeconomic status, even with universal health coverage. Addressing these disparities is crucial for equitable, high-quality treatment outcomes in high-income nations.
Area of Science:
- Cardiology
- Public Health
- Health Equity
Background:
- Congenital heart disease (CHD) is a prevalent birth defect, impacting 1% of newborns globally.
- Survival rates for CHD have dramatically improved in high-income countries (HICs) due to medical advances and financial protection, with over 90% surviving to adulthood.
- Despite universal health coverage in HICs, significant barriers persist in accessing comprehensive cardiovascular and non-cardiovascular care for individuals with CHD.
Purpose of the Study:
- To examine the intricate relationship between socioeconomic status (SES) and access to CHD care within universal health coverage (UHC) systems.
- To identify and analyze key challenges hindering equitable access to high-quality CHD care.
- To explore potential opportunities for enhancing the quality and equity of CHD care delivery in HICs.
Main Methods:
- This review synthesizes existing literature on CHD care access and socioeconomic disparities.
- It analyzes data and research focusing on universal health coverage models in high-income countries.
- The study evaluates the impact of SES on accessing both specialized cardiac and general healthcare services for CHD patients.
Main Results:
- Lower socioeconomic status is consistently linked to disparities in accessing cardiac care and achieving favorable outcomes for various cardiovascular conditions, including CHD.
- Even within UHC frameworks, individuals with lower SES face greater obstacles in obtaining timely and high-quality CHD-related healthcare.
- These disparities affect access to both specialized cardiovascular interventions and essential non-cardiovascular services required for comprehensive CHD management.
Conclusions:
- Socioeconomic status remains a critical determinant of CHD care access and outcomes, irrespective of universal health coverage.
- Addressing socioeconomic barriers is paramount to achieving true health equity in CHD management.
- Strategic interventions are needed to overcome these challenges and ensure all individuals with CHD receive equitable, high-quality care.
Abstract:
Congenital heart disease (CHD) is the most common major congenital anomaly, affecting one in every 100 live births. Whereas over 90% of children born with CHD in low- and middle-income countries cannot access the care they need, early detection, advances in management, and financial risk protection have resulted in over 90% of children with CHD in high-income countries surviving into adulthood. Despite the presence of universal health coverage, barriers to accessing high-quality cardiovascular and non-cardiovascular care for CHD remain common. Lower socioeconomic status has been associated with differential access to cardiac care and poorer outcomes across multiple cardiovascular conditions and subspecialties. In this review article, we describe the relationship between socioeconomic status and access to CHD care in countries with universal health coverage models. We further evaluate notable challenges and opportunities to improve equitable, high-quality CHD care in these countries.
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