In the Journals

Proximity to specialized centers may predict congenital heart disease mortality

Jonathan R. Kaltman

The risk for congenital heart disease-related infant mortality was higher when mothers lived farther from specialized pediatric cardiac centers, according to a research letter published in Circulation.

“Most importantly, the findings identify a new source of disparity in terms of infant mortality due to congenital heart disease,” Jonathan R. Kaltman, MD, chief of the heart development and structural diseases branch of the NHLBI, told Healio. “We have known that black infants and infants with greater poverty experience worse outcomes. This study shows that maternal proximity to a top-ranked pediatric cardiac center also affects outcomes, with infants of mothers who do not live within a metropolitan area with a top-ranked pediatric cardiac center having 28% higher infant mortality rates than those that live within those metropolitan areas. This risk factor is robust across various demographic and socioeconomic strata.”

Researchers analyzed linked birth/infant death data from the National Center for Health Statistics at the CDC of infants who were born from 2011 to 2015. Deaths of infants younger than 365 days were included in the study.

The outcome of interest was death related to congenital heart disease. The main exposure of interest in this study was proximity to one of 50 top pediatric cardiac centers according to U.S. News & World Report in 2017.

The unadjusted rate for congenital heart disease-related infant mortality from 2011 to 2015 was 0.33 per 1,000 live births. This rate for mothers who lived in proximity to a top pediatric cardiac center was 0.28 per 1,000 live births compared with 0.37 per 1,000 live births for those who did not live close to a top center. The unadjusted mortality rate was 0.37 per 1,000 live births for mothers who lived in proximity to a specialized center that was not in the top 50 list. Lower mortality rates were observed in each covariate stratum except when other insurance covered the delivery.

Researchers also performed a Poisson regression analysis, which found that proximity to a top 50 pediatric cardiac center was associated with infant mortality from congenital heart disease. Compared with infants whose mothers lived close to top cardiac centers, infants of mothers who did not live close to these centers had a 28% greater rate mortality associated with congenital heart disease (adjusted RR = 1.28; 95% CI, 1.21-1.35). These results were consistent across subgroups except for insurance (P = .04).

There was a consistent relation between proximity to a top 50 center and infant mortality from congenital heart disease for critical (aRR = 1.33; 95% CI, 1.21-1.47) and noncritical congenital heart disease (aRR = 1.23; 95% CI, 1.1-1.38).

“At this point, we need a better understanding of the etiology of this disparity before we can structure an intervention to mitigate it,” Kaltman said in an interview. “However, it is reasonable to say that close coordination and communication between the family, local providers and the pediatric cardiac center is especially critical for those infants whose families live outside of the metropolitan area with the cardiac center.” – by Darlene Dobkowski

For more information:

Jonathan R. Kaltman, MD, can be reached at kaltmanj@nhlbi.nih.gov.

Disclosures: The authors report no relevant financial disclosures.

Jonathan R. Kaltman

The risk for congenital heart disease-related infant mortality was higher when mothers lived farther from specialized pediatric cardiac centers, according to a research letter published in Circulation.

“Most importantly, the findings identify a new source of disparity in terms of infant mortality due to congenital heart disease,” Jonathan R. Kaltman, MD, chief of the heart development and structural diseases branch of the NHLBI, told Healio. “We have known that black infants and infants with greater poverty experience worse outcomes. This study shows that maternal proximity to a top-ranked pediatric cardiac center also affects outcomes, with infants of mothers who do not live within a metropolitan area with a top-ranked pediatric cardiac center having 28% higher infant mortality rates than those that live within those metropolitan areas. This risk factor is robust across various demographic and socioeconomic strata.”

Researchers analyzed linked birth/infant death data from the National Center for Health Statistics at the CDC of infants who were born from 2011 to 2015. Deaths of infants younger than 365 days were included in the study.

The outcome of interest was death related to congenital heart disease. The main exposure of interest in this study was proximity to one of 50 top pediatric cardiac centers according to U.S. News & World Report in 2017.

The unadjusted rate for congenital heart disease-related infant mortality from 2011 to 2015 was 0.33 per 1,000 live births. This rate for mothers who lived in proximity to a top pediatric cardiac center was 0.28 per 1,000 live births compared with 0.37 per 1,000 live births for those who did not live close to a top center. The unadjusted mortality rate was 0.37 per 1,000 live births for mothers who lived in proximity to a specialized center that was not in the top 50 list. Lower mortality rates were observed in each covariate stratum except when other insurance covered the delivery.

Researchers also performed a Poisson regression analysis, which found that proximity to a top 50 pediatric cardiac center was associated with infant mortality from congenital heart disease. Compared with infants whose mothers lived close to top cardiac centers, infants of mothers who did not live close to these centers had a 28% greater rate mortality associated with congenital heart disease (adjusted RR = 1.28; 95% CI, 1.21-1.35). These results were consistent across subgroups except for insurance (P = .04).

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There was a consistent relation between proximity to a top 50 center and infant mortality from congenital heart disease for critical (aRR = 1.33; 95% CI, 1.21-1.47) and noncritical congenital heart disease (aRR = 1.23; 95% CI, 1.1-1.38).

“At this point, we need a better understanding of the etiology of this disparity before we can structure an intervention to mitigate it,” Kaltman said in an interview. “However, it is reasonable to say that close coordination and communication between the family, local providers and the pediatric cardiac center is especially critical for those infants whose families live outside of the metropolitan area with the cardiac center.” – by Darlene Dobkowski

For more information:

Jonathan R. Kaltman, MD, can be reached at kaltmanj@nhlbi.nih.gov.

Disclosures: The authors report no relevant financial disclosures.