Abstract 4369029: Regional and Temporal Mortality Trends of Congenital Cardiovascular Malformations in Patients with Chromosomal Abnormalities in the United States from 1999 to 2020

Background: Congenital cardiovascular malformations (CVMs) affect 0.5 to 0.7% of all live born infants. Chromosomal abnormalities (CA) both increase CVM severity and contribute to higher mortality, yet their regional and temporal mortality patterns remain poorly characterized. Aims: This study aimed to analyze 1999-2020 mortality trends, comparing CVM patients with and without CA to identify disparities. Methods: The CDC WONDER dataset was used to derive crude (CMR) and age-adjusted mortality rates (AAMR) per 1,000,000 population, stratified by year, gender, race, and region. We identified CVM-related deaths using ICD-10 codes Q20-Q28 and CAs-related deaths using ICD-10 codes Q90-Q99. Average annual percentage changes (AAPC) were assessed by Joinpoint regression. Results: 117,837 CVM-related deaths occurred over 2+ decades, with 10% (12,049) involving co-existing CA. AAMRs steadily declined over time in patients without coexisting CA (AAPC: -1.9) but remained unchanged in patients with CA (AAPC: -1, p < 0.001). Females having CVM with CA had a slightly higher AAMR (2.21) as compared to males (1.59). Hispanics or Latino patients with coexisting CA had higher AAMR (1.90) as compared to non-Hispanics (1.85). Infants having CVM with CA displayed the highest AAMR (100.64) with a decline in mortality during the study period (AAPC = -0.40, p < 0.05), whereas deaths declined across all age groups. Mortality rates were higher in rural areas, the Midwest, and states with fewer accredited adult congenital heart disease centers (Figure). Conclusion: CVM mortality steadily declined in patients without CA but remained unchanged in those with CA in the last two decades. These results may help optimize public health policy.