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Association of Material Hardship and Clinical Outcomes in Infants with Congenital Heart Disease

Meredith Sooy-Mossey1,2, Meaghan O'Connor3, Alexander Bowers4,5

  • 1Department of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, Durham, NC, USA. sooymosseym24@ecu.edu.

Pediatric Cardiology
|February 17, 2026
PubMed

Insights

Material hardship, including financial insecurity, is linked to higher mortality and longer hospital stays in infants with congenital heart disease (CHD). Addressing these challenges early may improve outcomes for these children.

Area of Science:

  • Pediatric Cardiology
  • Health Equity Research
  • Social Determinants of Health

Background:

  • Material hardship, encompassing housing, food, energy, and transportation insecurity, significantly impacts pediatric health outcomes.
  • The specific role of material hardship in the outcomes of children with congenital heart disease (CHD) remains under-examined.
  • Early identification of material hardship is crucial for improving health equity in vulnerable pediatric populations.

Purpose of the Study:

  • To investigate the association between material hardship and mortality and healthcare utilization in infants diagnosed with CHD prenatally.
  • To analyze the impact of financial insecurity and housing insecurity on infant outcomes within the first six months of life.
  • To establish a baseline understanding for developing targeted interventions to mitigate the adverse effects of material hardship.

Main Methods:

  • Prospective cohort study enrolling pregnant patients at fetal CHD diagnosis.
  • Collection of material hardship and sociodemographic data via validated surveys at diagnosis and 6 months postpartum.
  • Assessment of infant outcomes including mortality and healthcare utilization (length of stay) during the birth hospitalization and first six months of life.

Main Results:

  • Overall mortality rate was 8.6% in the first six months among infants with CHD.
  • At baseline, 36.1% of families reported at least one type of material hardship, decreasing to 27.6% at 6 months.
  • Financial insecurity (income < 200% federal poverty line) at baseline was associated with increased mortality (p=0.05).
  • Housing insecurity and any material hardship were linked to significantly longer hospital stays (median LOS 28 vs. 16 days, p<0.05).

Conclusions:

  • Increased material hardship and financial insecurity are significantly associated with higher mortality and prolonged length of stay in infants with CHD.
  • These findings underscore the critical need for interventions to address material hardship early in the care of infants with CHD.
  • Addressing these socioeconomic factors may reduce morbidity and healthcare utilization, promoting health equity in this population.

Keywords:
Health EquityMaterial HardshipPrenatal Diagnosis

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