School of Medicine and Health Sciences Poster Presentations

Title

Impact of socioeconomic and geographic factors on prenatal diagnosis of hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (d-TGA)

Poster Number

146

Document Type

Poster

Status

Medical Student

Abstract Category

Cardiology/Cardiovascular Research

Keywords

Congenital heart disease

Publication Date

Spring 2018

Abstract

Congenital heart disease (CHD) is the most common birth defect and persists as a significant cause of neonatal and infant mortality in the United States. Prenatal detection of CHD allows for timely decision making and planning for delivery and may improve postnatal outcomes, especially in specific congenital heart defects, including hypoplastic left heart syndrome (HLHS) and D-transposition of the great arteries (D-TGA). Prenatal diagnosis remains low, however, despite nearly universal use of ultrasound during fetal development. Therefore, defining barriers to diagnosis will be essential to improving these rates. The purpose of the current study was to describe the following socioeconomic and geographic factors in subjects diagnosed with HLHS and d-TGA at Children’s National Medical Center: percentage of households living in poverty, median household income, median value of housing, population > 50% of a vulnerable ethnicity (African American, Hispanic, Native American), education level, and distance from a cardiac surgical center.

Retrospective chart review was performed for subjects with HLHS and D-TGA who had their first admission/visit recorded at Children’s National Medical Center between January 1, 2012 and December 31, 2016. Using maternal address, cdxzipstream software derived census tract data to assess socioeconomic factors.

105 subjects met inclusion criteria for the study. 59 subjects had a diagnosis of HLHS and 46 had a diagnosis of D-TGA. Census data revealed the mean of households in poverty as 9.58% (range 0.38-33.38%). Average median household income was $83,142 (range $25,957-$250,000) and average median housing value was $349,425 (range $89,000-$1,042,600). 38 census areas were >50% vulnerable ethnicities. On average, census areas were 11.64% Hispanic (range 0-79.94%), 28.13% Black (range 0-99.5%), and 0.32% Native American (range 0-7.43%). 41.54% (range 6.38-76.55%) of persons age 25+ possessed a high school degree and 49.05% (range 5.73-93.34%) of persons age 25+ possessed a bachelor’s degree or higher. As a measure of access to care, distance from a pediatric cardiac surgical center was assessed. Census areas were an average of 30.42 miles by car with an estimated 43 minutes of travel time and 33.62 miles using public transportation with an estimated 158 mins of travel time. Results analyzing differences in outcomes and socioeconomic factors between prenatal and postnatal diagnosis are pending.

By evaluating the relationship of socioeconomic and geographic factors to prenatal diagnosis of CHD, interventions can be implemented to eliminate barriers to diagnosis as well as overlapping barriers in clinical management for vulnerable populations.

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Impact of socioeconomic and geographic factors on prenatal diagnosis of hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (d-TGA)

Congenital heart disease (CHD) is the most common birth defect and persists as a significant cause of neonatal and infant mortality in the United States. Prenatal detection of CHD allows for timely decision making and planning for delivery and may improve postnatal outcomes, especially in specific congenital heart defects, including hypoplastic left heart syndrome (HLHS) and D-transposition of the great arteries (D-TGA). Prenatal diagnosis remains low, however, despite nearly universal use of ultrasound during fetal development. Therefore, defining barriers to diagnosis will be essential to improving these rates. The purpose of the current study was to describe the following socioeconomic and geographic factors in subjects diagnosed with HLHS and d-TGA at Children’s National Medical Center: percentage of households living in poverty, median household income, median value of housing, population > 50% of a vulnerable ethnicity (African American, Hispanic, Native American), education level, and distance from a cardiac surgical center.

Retrospective chart review was performed for subjects with HLHS and D-TGA who had their first admission/visit recorded at Children’s National Medical Center between January 1, 2012 and December 31, 2016. Using maternal address, cdxzipstream software derived census tract data to assess socioeconomic factors.

105 subjects met inclusion criteria for the study. 59 subjects had a diagnosis of HLHS and 46 had a diagnosis of D-TGA. Census data revealed the mean of households in poverty as 9.58% (range 0.38-33.38%). Average median household income was $83,142 (range $25,957-$250,000) and average median housing value was $349,425 (range $89,000-$1,042,600). 38 census areas were >50% vulnerable ethnicities. On average, census areas were 11.64% Hispanic (range 0-79.94%), 28.13% Black (range 0-99.5%), and 0.32% Native American (range 0-7.43%). 41.54% (range 6.38-76.55%) of persons age 25+ possessed a high school degree and 49.05% (range 5.73-93.34%) of persons age 25+ possessed a bachelor’s degree or higher. As a measure of access to care, distance from a pediatric cardiac surgical center was assessed. Census areas were an average of 30.42 miles by car with an estimated 43 minutes of travel time and 33.62 miles using public transportation with an estimated 158 mins of travel time. Results analyzing differences in outcomes and socioeconomic factors between prenatal and postnatal diagnosis are pending.

By evaluating the relationship of socioeconomic and geographic factors to prenatal diagnosis of CHD, interventions can be implemented to eliminate barriers to diagnosis as well as overlapping barriers in clinical management for vulnerable populations.