Abstract 4142897: The Burden of Adult Congenital Heart Disease in the United States

Introduction: The Global Burden of Disease (GBD) study provides a unique opportunity to better understand fatal and nonfatal outcomes and their socioeconomic drivers in adults with congenital heart disease (ACHD). The aim of this study is to better understand trends in ACHD in the US and to analyze socioeconomic factors that may be correlated to geographic differences in patient outcomes. Methods: State specific data on mortality, prevalence, and disability adjusted life years (DALY) were acquired from GBD Database from 1990 to 2021 for ACHD patients aged 20 years and older in the USA. We subsequently correlated this data with median household income and percent uninsured in each state by using the US census bureau poverty and income data. Results: There are 292,625 (95% CI 258,956 – 342,906) adults > 20 years in the USA living with CHD in 2021 (compared to 212,366 in 1990). In 2021, ACHD was responsible for 1074 (CI 964 -1331) deaths and 62,244 (CI 51,820 – 76,301) DALYs ( FIGURE 1 ). Between 1990 and 2021 there was a decrease in rates of mortality (0.79 to 0.43/100,000) and DALYs (44 to 25/100,000). There is considerable variation by state. The state with the highest mortality and DALYs (West Virginia) also has one of the lowest median household incomes ($51,122). States with lower ACHD mortality have higher median household incomes (r 2 =0.612, p<0.001) ( FIGURE 2 ). The percent uninsured in each state also has a positive correlation with mortality (r 2 =0.142, p=0.006). Conclusion: The GBD study provides unique insight into ACHD mortality, prevalence, and disability and should be considered the gold standard for prevalence, disablity and mortality in the US. While mortality and disability rates have decreased from 1990 to 2021, ACHD patients living in states with lower median household income and higher percent uninsured have higher rates of mortality and disability. Investment into more equitable access to care is warranted for this population.