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Original Articles

Association of Socioeconomic Position and Medical Insurance With Fetal Diagnosis of Critical Congenital Heart Disease

Vasum Peiris, MD, MPH; Tajinder P. Singh, MD, MSc; Wayne Tworetzky, MD; Erin C. Chong, BA; Kimberlee Gauvreau, ScD and David W. Brown, MD

From the Department of Cardiology (V.P., T.P.S., W.T., E.C.C., K.G., D.W.B.), Children’s Hospital Boston, and the Department of Pediatrics (V.P., T.P.S., W.T., D.W.B.), Harvard Medical School, Boston, Mass.

Correspondence to Vasum Peiris, MD, MPH, Children’s Hospital Boston/Harvard Medical School, 300 Longwood Ave, Boston, MA 02115. E-mail Vasum{at}aya.yale.edu

Received July 2, 2008; accepted April 27, 2009.

Background— Access to beneficial novel healthcare technology has been inequitable in the United States. Fetal echocardiography, used with increasing frequency for prenatal diagnosis (PD) of congenital heart disease, allows for optimal neonatal management and possible improved outcomes. We sought to evaluate whether PD of critical congenital heart disease is related to socioeconomic (SE) position, medical insurance, and race.

Methods and Results— In a retrospective review of infants with critical congenital heart disease who underwent surgical or catheter intervention at age <30 days in our institution during 2003 to 2006, we extracted 6 SE variables for the block groups of patient residence from 2000 US Census and calculated a previously validated composite SE score for each patient. PD occurred in 222 (50%) infants. Race was not significantly associated with PD. Private insurance patients were much more likely to have PD (odds ratio, 3.7 versus public insurance; 95% CI, 2.4 to 5.7; P<0.001), as were patients of higher SE position (PD, 62% in highest quartile versus 35% in lowest quartile; P=0.001). Odds of PD increased with increasing SE score (odds ratio, 1.7, 2.3, and 2.9 for each quartile of higher SE score versus those in lowest SE quartile; P<0.001). Patients from economically poor neighborhoods were less likely to have PD (odds ratio, 1.2 for each 10% increase in prevalence of poverty; P=0.04). Private medical insurance (odds ratio, 3.4; 95% CI, 2.1 to 5.5; P<0.001) was the strongest predictor of PD in the logistic regression model.

Conclusion— Patients with public insurance and lower SE position are less likely to have a PD of critical congenital heart disease.

Key Words: echocardiography • heart defects, congenital • imaging • access to health care

Craig T. Basson, MD, PhD, was Guest Editor for this article.