Association of Material Hardship and Clinical Outcomes in Infants with Congenital Heart Disease

Material hardship is the degree to which families experience housing, food, energy and transportation insecurity. It has been shown to affect various pediatric outcomes. However, it is unclear what role it plays in outcomes in children with congenital heart disease (CHD). To examine the association between material hardship and mortality and healthcare utilization among infants with CHD starting at prenatal diagnosis. We enrolled pregnant patients at the time of prenatal diagnosis of fetal CHD. We collected level of material hardship and sociodemographic factors using validated surveys at the time of prenatal diagnosis and when the infant was 6 months of age. We assessed outcomes at birth hospitalization and during the first six months of life. The cohort include 58 families with a diverse racial and socioeconomic make-up. There was an overall mortality rate of 8.6% in the first 6 months. At baseline 36.1% of the families had at least one type of material hardship compared to 27.6% at 6 months. Families with income at < 200% of the federal poverty line were 27.6% baseline compared to 20.7% at 6 months. Income < 200% of the federal (financial insecurity) at baseline was associated with increased mortality (p = 0.05). There was an increased length of stay those with housing insecurity (median LOS 28 vs. 16 days, p = 0.032) and in those with any type of material hardship (median LOS 28 vs. 16 days, p = 0.047). Increased levels of material hardship and financial insecurity were associated with increased mortality and length of stay in infants with CHD. Further research is needed to assesses the benefit of interventions designed to identify and address these gaps early since they may reduce morbidity and healthcare utilization. Keywords: Material Hardship, Health Equity, Prenatal Diagnosis.