Socioeconomic Barriers for Newly Transferred Young Adults With Congenital Heart Disease

<h2>Abstract</h2><h3>Background</h3> This study aimed to ascertain socioeconomic factors affecting successful transfer to adult congenital cardiology and cardiac surgical services in Ontario. <h3>Methods</h3> 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. <h3>Results</h3> 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, <i>P</i> < 0.001) and being unable to travel to work by car (OR: 0.986, <i>P</i> < 0.001) were both associated with FT, though the latter is not clinically relevant. Residential addresses with lower income (OR: 0.976, <i>P</i> = 0.016) were associated with LTFU. Factors associated with CS were higher household income (<i>P</i> < 0.001), access to a car for travel to work (<i>P</i> < 0.001), Canadian citizenship (<i>P</i> = 0.041), and French or English as the primary language in the home (<i>P</i> = 0.038). <h3>Conclusions</h3> Socioeconomic factors are associated with access to specialized ACHD services among young adults. Strategies to ensure equity in care should be explored.