Congenital Cardiac Surgical Workforce Inequities Across 194 Countries: A Global Cross-Sectional Analysis

Congenital heart disease is the most common birth defect globally, yet access to surgery remains inequitable. The availability of congenital heart surgeons (CHS) relative to paediatric population needs is poorly defined. A cross-sectional study of the Cardiothoracic Surgery Network was conducted across 194 United Nations-recognised countries and 54 territories and dependencies (T&Ds). Of 248 countries and T&Ds analysed, 123 (49.6%) had ≥ 1 CHS. A total of 4,296 CHS were identified; 71 (37% of recognised) countries with 189.5 million children had none. Low-income countries had a median of 0.15 CHS per million children compared with 9.29 in high-income countries. CHS density was strongly correlated with gross domestic product per capita. Average CHS ratios per million children were: high-income country 9.3, upper-middle-income country 2.0, lower-middle-income country 1.1, and low-income country 0.2 (p < 0.0001), representing a 46-fold disparity between high-income countries and low-income countries. Regional analysis showed North America and Europe had the highest CHS ratios (≥ 9 per million), and Sub-Saharan Africa and East Asia and Pacific had medians of zero (p < 0.0001). Only 3 T&Ds reported at least one CHS. Our findings confirm that human resource levels are even more disproportionate than previously estimated. A significant proportion of children globally remain without access to cardiac surgery, representing a major and largely unquantified burden of preventable morbidity and mortality. Accurately quantifying this unmet need should be an urgent priority for future population-level and health systems research.