Neighborhood-level socioeconomic position and mortality among children born with critical congenital heart defects
We examined the role of nSEP on 1-year and 5-year survival among children with critical congenital heart defects (CCHDs). Children with CCHDs in the National Birth Defects Prevention Study (1999-2011) were grouped into univentricular and biventricular defects and linked to vital records for 1-year and 5-year mortality. The Neighborhood Deprivation Index (NDI) classified census-tract nSEP (low [referent], moderate, high deprivation) using maternal periconceptional address. Kaplan-Meier survival curves and log-rank tests evaluated survival differences. Cox proportional hazards regression models estimated crude and adjusted hazard ratios (HRs) and 95% confidence intervals, adjusting for birth years, maternal sociodemographic factors, and residential mobility. Among 2459 children with CCHDs, 1-year survival curves differed by neighborhood deprivation. Survival was lowest among children of mothers living in high vs. low deprivation neighborhoods. In crude analyses, high deprivation was associated with higher 1-year mortality (all CCHDs: 1.58 [1.17, 2.13]; univentricular CCHDs: 1.50 [0.99, 2.26]; biventricular CCHDs: 1.64 [1.02, 2.64]). After adjustment, estimates were generally attenuated and less precise. Five-year survival showed similar trends. Further research could inform strategies to address the structural, environmental, and/or physiological factors associated with a potential reduced survival among children with CCHDs born to mothers in socioeconomically deprived areas.
Authors
- Suzan L. Carmichael (ORCID: https://orcid.org/0000-0001-6310-5924)
- Chantel L. Martin (ORCID: https://orcid.org/0000-0003-1907-0810)
- Elizabeth C. Ailes (ORCID: https://orcid.org/0000-0003-2062-8148)
- Thomas J. Luben (ORCID: https://orcid.org/0000-0002-7867-5126)
- A F. Olshan
- Sarah C. Fisher (ORCID: https://orcid.org/0000-0002-4702-1007)
- Tania A. Desrosiers (ORCID: https://orcid.org/0000-0003-1600-3700)
- Paul A. Romitti (ORCID: https://orcid.org/0000-0001-5393-9984)
- Matthew E. Oster (ORCID: https://orcid.org/0000-0002-2243-8367)
- Shannon Pruitt Evans (ORCID: https://orcid.org/0000-0002-9954-3720)
- Philip J. Lupo (ORCID: https://orcid.org/0000-0003-0978-5863)
- Wendy N. Nembhard (ORCID: https://orcid.org/0000-0002-8318-4049)
- Anne Marie Darling (ORCID: https://orcid.org/0000-0002-2282-7696)
- Nina Forestieri (ORCID: https://orcid.org/0000-0001-7894-0279)
- Jeanette A. Stingone (ORCID: https://orcid.org/0000-0003-3508-8260)
- the National Birth Defects Prevention Study
- Sanjida Jahan Mowla
Institutions
- University of North Carolina at Chapel Hill (US)
- University of Iowa (US)
- Centers for Disease Control and Prevention (US)
- NC Department of Health and Human Services (US)
- New York State Department of Health (US)
- Massachusetts Department of Public Health (US)
- Baylor College of Medicine (US)
- Centers for Disease Control and Prevention (UG)
- National Center on Birth Defects and Developmental Disabilities (US)
- North Carolina Division of Public Health (US)
- Stanford Medicine (US)
- Children's Healthcare of Atlanta (US)
- Texas Children's Hospital (US)
- Children's Cancer Center (US)
- Columbia University (US)
- University of Arkansas for Medical Sciences (US)
- Stanford University (US)
Publication Details
- Journal
- American Journal of Epidemiology
- Published
- 2026-04-15
- DOI
- https://doi.org/10.1093/aje/kwag078
- Primary Topic
- Congenital Heart Disease Studies
- Type
- article
- Field-Weighted Citation Impact
- 0.00