Social Determinants of Disparities in Mortality Outcomes in Congenital Heart Disease: A Systematic Review and Meta-Analysis

Frontiers in Cardiovascular Medicine

article

Richard Tran¹  Rebecca Forman¹  Elias Mossialos¹  Khurram Nasir²  Aparna Kulkarni³ 

[1] Department of Health Policy, London School of Economics and Political Science;Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital;Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine

关键词: congenital heart disease;    death;    social determinants of health;    health disparities;    health inequalities;   

DOI  :  10.3389/fcvm.2022.829902

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Social determinants of health (SDoH) affect congenital heart disease (CHD) mortality across all forms and age groups. We sought to evaluate risk of mortality from specific SDoH stratified across CHD to guide interventions to alleviate this risk. Methods We searched electronic databases between January 1980 and June 2019 and included studies that evaluated occurrence of CHD deaths and SDoH in English articles. Meta-analysis was performed if SDoH data were available in > 3 studies. We included race/ethnicity, deprivation, insurance status, maternal age, maternal education, single/multiple pregnancy, hospital volume, and geographic location of patients as SDoH. Data were pooled using random-effects model and outcome was reported as odds ratio (OR) with 95% confidence interval (CI). Results Of 17,716 citations reviewed, 65 met inclusion criteria. Sixty-three were observational retrospective studies and two prospective. Of 546,981 patients, 34,080 died. Black patients with non-critical CHD in the first year of life (Odds Ratio 1.62 [95% confidence interval 1.47–1.79], I 2 = 7.1%), with critical CHD as neonates (OR 1.27 [CI 1.05-1.55], I 2 = 0%) and in the first year (OR 1.68, [1.45-1.95], I 2 = 0.3%) had increased mortality. Deprived patients, multiple pregnancies, patients born to mothers 18 years and with education <12 years, and patients on public insurance with critical CHD have greater likelihood of death after the neonatal period. Conclusion This systematic review and meta-analysis found that Black patients with CHD are particularly vulnerable for mortality. Numerous SDoH that affect mortality were identified for specific time points in CHD course that may guide interventions, future research and policy.

【 授权许可】

CC BY