Socioeconomic Barriers for Newly Transferred Young Adults With Congenital Heart Disease

This study aimed to ascertain socioeconomic factors affecting successful transfer to adult congenital cardiology and cardiac surgical services in Ontario.

Patients with congenital heart disease (CHD) referred from a pediatric CHD program to an adult CHD (ACHD) center between January 1, 2004, and December 31, 2015, were identified. The prevalence of (1) failed transfer (FT), (2) lost to follow-up (LTFU), and (3) cardiac surgery (CS) during the extended study period of 2004-2018 was investigated. Socioeconomic variables associated with FT, LTFU, and CS were explored using Environics data associated with postal code at the time of transfer.

A total of 2196 patients were referred from the pediatric to ACHD center between 2004 and 2015. Within this cohort, 11% had FT and 25% had LTFU; there was a 2% overlap between the FT and LTFU groups. A total of 106 patients (4.8%) underwent CS. Age at referral (odds ratio [OR]: 0.591, P < 0.001) and being unable to travel to work by car (OR: 0.986, P < 0.001) were both associated with FT, though the latter is not clinically relevant. Residential addresses with lower income (OR: 0.976, P = 0.016) were associated with LTFU. Factors associated with CS were higher household income (P < 0.001), access to a car for travel to work (P < 0.001), Canadian citizenship (P = 0.041), and French or English as the primary language in the home (P = 0.038).

Socioeconomic factors are associated with access to specialized ACHD services among young adults. Strategies to ensure equity in care should be explored.