Racial and Ethnic Disparities in Healthcare Utilization and Mortality by Neighborhood Poverty among Individuals with Congenital Heart Defects, four U.S. Surveillance Sites, 2011-2013

BACKGROUND Socioeconomic factors may lead to a disproportionate impact on healthcare utilization and mortality among individuals with congenital heart defects (CHD) by race, ethnicity, and socio-economic factors. How neighborhood poverty affects racial and ethnic disparities in healthcare utilization and mortality among individuals with CHD across the lifespan is not well described. METHODS Individuals, 1-64 years, with at least one CHD-related ICD-9-CM code were identified from healthcare encounters between 01/01/2011-12/31/2013 from four U.S. sites. Residence was classified into lower or higher poverty neighborhoods based on ZCTA from the 2014 American Community Survey 5-Year Estimates. Multivariable logistic regression models, adjusting for site, sex, CHD anatomic severity, and insurance evaluated associations between race and ethnicity, and healthcare utilization and mortality, stratified by neighborhood poverty. RESULTS Of 31,542 individuals, 22.2% were non-Hispanic Black (nHB) and 17.0% Hispanic. In high poverty neighborhoods, nHB (44.4%) and Hispanic (47.7%) individuals, respectively, were more likely to be hospitalized (aOR)=1.2 [95%CI=1.0-1.3] and aOR=1.3 [95%CI=1.2-1.5]) and have ED visits (aOR=1.3 [95%CI=1.2-1.5] and aOR=1.7 [95%CI=1.5-2.0]) compared to non-Hispanic White (nHW) individuals. In high poverty neighborhoods, nHB individuals with CHD had 1.7 times the odds of mortality compared to nHW individuals in high poverty neighborhoods (95%CI=1.1-2.7). Racial and ethnic disparities in healthcare utilization were similar in low poverty neighborhoods, but disparities in mortality were attenuated (aOR for nHB=1.2 [95%CI=0.9-1.7]). CONCLUSIONS Racial and ethnic disparities in healthcare utilization were found among individuals with CHD in low and high poverty neighborhoods, but mortality disparities were larger in high poverty neighborhoods. Understanding individual- and community-level social determinants of health, including access to healthcare, may help address racial and ethnic inequities in healthcare utilization and mortality among individuals with CHD. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Source of Funding: Centers for Disease Control and Prevention, Grant/Award Number: CDC-RFA-DD15-1506 ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Emory University IRB I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Contact Jill Glidewell at Centers for Disease Control and Prevention for data availability