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Judge A, Kramer M, Downing KF, Andrews J, Oster ME, Benavides A, Nembhard WN, Farr SL. Neighborhood social deprivation and healthcare utilization, disability, and comorbidities among young adults with congenital heart defects: Congenital heart survey to recognize outcomes, needs, and well-being 2016-2019. Birth Defects Res 2023; 115:1608-1618. [PMID: 37578352 PMCID: PMC10916520 DOI: 10.1002/bdr2.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Research on the association between neighborhood social deprivation and health among adults with congenital heart defects (CHD) is sparse. METHODS We evaluated the associations between neighborhood social deprivation and health care utilization, disability, and comorbidities using the population-based 2016-2019 Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) of young adults. Participants were identified from active birth defect surveillance systems in three U.S. sites and born with CHD between 1980 and 1997. We linked census tract-level 2017 American Community Survey information on median household income, percent of ≥25-year-old with greater than a high school degree, percent of ≥16-year-olds who are unemployed, and percent of families with children <18 years old living in poverty to survey data and used these variables to calculate a summary neighborhood social deprivation z-score, divided into tertiles. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) derived from a log-linear regression model with a Poisson distribution estimated the association between tertile of neighborhood social deprivation and healthcare utilization in previous year (no encounters, 1 and ≥2 emergency room [ER] visits, and hospital admission), ≥1 disability, and ≥1 comorbidities. We accounted for age, place of birth, sex at birth, presence of chromosomal anomalies, and CHD severity in all models, and, additionally educational attainment and work status in all models except disability. RESULTS Of the 1435 adults with CHD, 43.8% were 19-24 years old, 54.4% were female, 69.8% were non-Hispanic White, and 33.7% had a severe CHD. Compared to the least deprived tertile, respondents in the most deprived tertile were more likely to have no healthcare visit (aPR: 1.5 [95% CI: 1.1, 2.1]), ≥2 ER visits (1.6 [1.1, 2.3]), or hospitalization (1.6 [1.1, 2.3]) in the previous 12 months, a disability (1.2 [1.0, 1.5]), and ≥1 cardiac comorbidities (1.8 [1.2, 2.7]). CONCLUSIONS Neighborhood social deprivation may be a useful metric to identify patients needing additional resources and referrals.
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Affiliation(s)
- Ashley Judge
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Michael Kramer
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Karrie F. Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Andrews
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona, USA
| | - Matthew E. Oster
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Argelia Benavides
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona, USA
| | - Wendy N. Nembhard
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sherry L. Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Downing KF, Klewer SE, Nembhard WN, Goudie A, Oster ME, Farr SL. Healthcare and Socioeconomic Outcomes Among Young Adults With Congenital Heart Defects and Functional Cognitive Disabilities, CH STRONG 2016 to 2019. Am J Cardiol 2023; 201:229-231. [PMID: 37390699 PMCID: PMC10527851 DOI: 10.1016/j.amjcard.2023.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/25/2023] [Indexed: 07/02/2023]
Affiliation(s)
- Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Scott E Klewer
- Department of Pediatrics, University of Arizona, Tucson, Arkansas
| | - Wendy N Nembhard
- Department of Epidemiology, Fay W Boozman College of Public Health and the Arkansas Center for Birth Defects Research and Prevention
| | - Anthony Goudie
- Arkansas Children's Research Institute; Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Downing KF, Nembhard WN, Rose CE, Andrews JG, Goudie A, Klewer SE, Oster ME, Farr SL. Survival From Birth Until Young Adulthood Among Individuals With Congenital Heart Defects: CH STRONG. Circulation 2023; 148:575-588. [PMID: 37401461 PMCID: PMC10544792 DOI: 10.1161/circulationaha.123.064400] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/12/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Limited population-based information is available on long-term survival of US individuals with congenital heart defects (CHDs). Therefore, we assessed patterns in survival from birth until young adulthood (ie, 35 years of age) and associated factors among a population-based sample of US individuals with CHDs. METHODS Individuals born between 1980 and 1997 with CHDs identified in 3 US birth defect surveillance systems were linked to death records through 2015 to identify those deceased and the year of their death. Kaplan-Meier survival curves, adjusted risk ratios (aRRs) for infant mortality (ie, death during the first year of life), and Cox proportional hazard ratios for survival after the first year of life (aHRs) were used to estimate the probability of survival and associated factors. Standardized mortality ratios compared infant mortality, >1-year mortality, >10-year mortality, and >20-year mortality among individuals with CHDs with general population estimates. RESULTS Among 11 695 individuals with CHDs, the probability of survival to 35 years of age was 81.4% overall, 86.5% among those without co-occurring noncardiac anomalies, and 92.8% among those who survived the first year of life. Characteristics associated with both infant mortality and reduced survival after the first year of life, respectively, included severe CHDs (aRR=4.08; aHR=3.18), genetic syndromes (aRR=1.83; aHR=3.06) or other noncardiac anomalies (aRR=1.54; aHR=2.53), low birth weight (aRR=1.70; aHR=1.29), and Hispanic (aRR=1.27; aHR=1.42) or non-Hispanic Black (aRR=1.43; aHR=1.80) maternal race and ethnicity. Individuals with CHDs had higher infant mortality (standardized mortality ratio=10.17), >1-year mortality (standardized mortality ratio=3.29), and >10-year and >20-year mortality (both standardized mortality ratios ≈1.5) than the general population; however, after excluding those with noncardiac anomalies, >1-year mortality for those with nonsevere CHDs and >10-year and >20-year mortality for those with any CHD were similar to the general population. CONCLUSIONS Eight in 10 individuals with CHDs born between1980 and 1997 survived to 35 years of age, with disparities by CHD severity, noncardiac anomalies, birth weight, and maternal race and ethnicity. Among individuals without noncardiac anomalies, those with nonsevere CHDs experienced similar mortality between 1 and 35 years of age as in the general population, and those with any CHD experienced similar mortality between 10 and 35 years of age as in the general population.
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Affiliation(s)
- Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (K.F.D., C.E.R., M.E.O., S.L.F.)
| | - Wendy N Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health and the Arkansas Center for Birth Defects Research and Prevention, University of Arkansas for Medical Sciences, Little Rock (W.N.N.)
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (K.F.D., C.E.R., M.E.O., S.L.F.)
| | - Jennifer G Andrews
- Department of Pediatrics, University of Arizona, Tucson (J.G.A., S.E.K.)
| | - Anthony Goudie
- Department of Pediatrics, Center for Applied Research and Evaluation, College of Medicine, Little Rock, AR (A.G.)
| | - Scott E Klewer
- Department of Pediatrics, University of Arizona, Tucson (J.G.A., S.E.K.)
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (K.F.D., C.E.R., M.E.O., S.L.F.)
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA (M.E.O.)
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (K.F.D., C.E.R., M.E.O., S.L.F.)
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Farr SL, Galindo M, Downing KF, Nembhard WN, Klewer SE, Judge AS, Bolin EH, Benavides A, Oster ME. Reproductive Health Counseling and Concerns Among Women with Congenital Heart Defects With and Without Disabilities. J Womens Health (Larchmt) 2023; 32:740-746. [PMID: 37184635 PMCID: PMC10680446 DOI: 10.1089/jwh.2022.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Background: Women with disabilities are less likely to receive reproductive health counseling than women without disabilities. Yet, little is known about reproductive health counseling and concerns among women with congenital heart defects (CHD) and disabilities. Methods: We used population-based survey data from 778 women aged 19 to 38 years with CHD to examine contraceptive and pregnancy counseling and pregnancy concerns and experiences by disability status, based on six validated questions on vision, hearing, mobility, cognition, self-care, and living independently. Multivariable Poisson regression was used to examine adjusted prevalence ratios between disability status and each outcome, adjusted for CHD severity, age, race/ethnicity, place of birth (Arkansas, Arizona, Georgia), and insurance type. Results: Women with disabilities (n = 323) were 1.4 and 2.3 times more likely than women without disabilities (n = 455) to receive clinician counseling on safe contraceptive methods and avoiding pregnancy because of their CHD. Women with CHD and disabilities, compared to those without disabilities, were more likely to be concerned about their ability to have children (aPR = 1.2) and to have delayed or avoided pregnancy (aPR = 2.2); they were less likely to have ever been pregnant (aPR = 0.7). Associations differed slightly across specific disability types. All associations remained after excluding 71 women with chromosomal anomalies. Conclusion: Among women with CHD, reproductive counseling, concerns, and experiences differ by disability status.
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Affiliation(s)
- Sherry L. Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maureen Galindo
- University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Karrie F. Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wendy N. Nembhard
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Scott E. Klewer
- University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Ashley S. Judge
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, University of California Santa Cruz, Santa Cruz, California, USA
| | - Elijah H. Bolin
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Argelia Benavides
- University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Matthew E. Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
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Andrews JG, Strah D, Downing KF, Kern MC, Oster ME, Seckeler MD, Goudie A, Nembhard WN, Farr SL, Klewer SE. Cardiology Care and Loss to Follow-Up Among Adults With Congenital Heart Defects in CH STRONG. Am J Cardiol 2023; 197:42-45. [PMID: 37148718 PMCID: PMC10236354 DOI: 10.1016/j.amjcard.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/22/2023] [Accepted: 04/03/2023] [Indexed: 05/08/2023]
Abstract
Many of the estimated 1.4 million adults with congenital heart defects (CHDs) in the United States are lost to follow-up (LTF) despite recommendations for ongoing cardiology care. Using 2016 to 2019 CH STRONG (Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG) data, we describe cardiac care among community-based adults with CHD, born in 1980 to 1997, identified through state birth defects registries. Our estimates of LTF were standardized to the CH STRONG eligible population and likely more generalizable to adults with CHD than clinic-based data. Half of our sample were LTF and more than 45% had not received cardiology care in over 5 years. Of those who received care, only 1 in 3 saw an adult CHD physician at their last encounter. Not knowing they needed to see a cardiologist, being told they no longer needed cardiology care, and feeling "well" were the top reasons for LTF, and only half of respondents report doctors discussing the need for cardiac follow-up.
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Affiliation(s)
| | - Danielle Strah
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew C Kern
- School of Medicine, University of Arizona, Tucson, Arizona
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | | | - Anthony Goudie
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Wendy N Nembhard
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Scott E Klewer
- Department of Pediatrics, University of Arizona, Tucson, Arizona
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Farr SL, Downing KF, Tepper NK, Oster ME, Glidewell MJ, Reefhuis J. Reproductive Health of Women with Congenital Heart Defects. J Womens Health (Larchmt) 2023; 32:132-137. [PMID: 36757282 PMCID: PMC10680443 DOI: 10.1089/jwh.2022.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
This report provides an overview of the unique reproductive health issues facing women with congenital heart defects (CHDs) and of the clinical care and professional guidelines on contraception, preconception care, and pregnancy for this population. It describes Centers for Disease Control and Prevention (CDC) activities related to surveillance of reproductive health issues among females with CHDs. It also describes CDC's work bringing awareness to physicians who provide care to adolescents and women with CHDs, including obstetrician/gynecologists, about the need for lifelong cardiology care for their patients with CHDs.
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Affiliation(s)
- Sherry L Farr
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F Downing
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naomi K Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew E Oster
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa J Glidewell
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Bolin EH, Ali MM, Farr SL, Oster ME, Klewer SE, Thomas RC, Seckeler MD, Nembhard WN. Health Insurance Status and Access to Healthcare Among Young Adults with Congenital Heart Disease: from the Congenital Heart Survey To Recognize Outcomes, Needs and Well-beinG (CH STRONG), 2016-2019. Pediatr Cardiol 2023:10.1007/s00246-023-03106-z. [PMID: 36693998 PMCID: PMC10680444 DOI: 10.1007/s00246-023-03106-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
Having health insurance is associated with better access to healthcare and lower rates of comorbidity in the general population, but data are limited on insurance's impact on adults with congenital heart disease (ACHD). The Congenital Heart Survey To Recognize Outcomes, Needs and well-beinG (CH STRONG) was conducted among ACHD in three locations from 2016 to 2019. We performed multivariable logistic regression to determine the associations between health insurance and both access to healthcare and presence of comorbidities. We also compared health insurance and comorbidities among ACHD to similarly-aged individuals in the Behavioral Risk Factor Surveillance System (BRFSS) as a proxy for the general population. Of 1354 CH STRONG respondents, the majority were ≤ 30 years old (83.5%), and 8.8% were uninsured versus 17.7% in the BRFSS (p < 0.01). Compared to insured ACHD, uninsured were less likely to report regular medical care (adjusted odds ratio [aOR] 0.2, 95% confidence interval [CI] 0.1-0.3) and visited an emergency room more often (aOR 1.6, CI 1.0-2.3). Among all ACHD reporting disability, uninsured individuals less frequently received benefits (aOR 0.1, CI 0.0-0.3). Depression was common among uninsured ACHD (22.5%), but insured ACHD had lower rates of depression than insured in the BRFSS (13.3% vs. 22.5%, p < 0.01). In conclusion, rates of insurance were higher among ACHD compared to the general population. Nonetheless, uninsured ACHD inconsistently accessed healthcare and benefits. Further studies are needed to determine if insurance ameliorates the risk of morbidity as ACHD age.
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Affiliation(s)
- Elijah H Bolin
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Box 512-3, Little Rock, AR, 72202, USA.
| | - Mir M Ali
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Scott E Klewer
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, AZ, USA
| | - R Collins Thomas
- Departments of Pediatrics and Internal Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Michael D Seckeler
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, AZ, USA
| | - Wendy N Nembhard
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Box 512-3, Little Rock, AR, 72202, USA
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, USA
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Farr SL, Riley C, Van Zutphen AR, Brei TJ, Leedom VO, Kirby RS, Pabst LJ. Prevention and awareness of birth defects across the lifespan using examples from congenital heart defects and spina bifida. Birth Defects Res 2021; 114:35-44. [PMID: 34921598 DOI: 10.1002/bdr2.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Sherry L Farr
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
| | - Catharine Riley
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
| | - Alissa R Van Zutphen
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Timothy J Brei
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA.,Spina Bifida Association of America, Arlington, Virginia, USA
| | - Vinita Oberoi Leedom
- Division of Population Health Surveillance, South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | | | - Laura J Pabst
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
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Farr SL, Downing KF, Goudie A, Klewer SE, Andrews JG, Oster ME. Advance Care Directives Among a Population-Based Sample of Young Adults with Congenital Heart Defects, CH STRONG, 2016-2019. Pediatr Cardiol 2021; 42:1775-1784. [PMID: 34164699 PMCID: PMC9808577 DOI: 10.1007/s00246-021-02663-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/14/2021] [Indexed: 01/05/2023]
Abstract
Little is known about advance care planning among young adults with congenital heart defects (CHD). Congenital Heart Survey to Recognize Outcomes, Needs, and well-beinG (CH STRONG) participants were born with CHD between 1980 and 1997, identified using active, population-based birth defects surveillance systems in Arkansas, Arizona and Atlanta, and Georgia, and surveyed during 2016-2019. We estimated the percent having an advance care directive standardized to the site, year of birth, sex, maternal race, and CHD severity of the 9312 CH STRONG-eligible individuals. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for characteristics associated with having advance care directives. Of 1541 respondents, 34.1% had severe CHD, 54.1% were female, and 69.6% were non-Hispanic white. After standardization, 7.3% had an advance care directive (range: 2.5% among non-Hispanic blacks to 17.4% among individuals with "poor" perceived health). Individuals with severe CHD (10.5%, aOR = 1.6, 95% CI: 1.1-2.3), with public insurance (13.1%, aOR = 1.7, 95% CI: 1.1-2.7), with non-cardiac congenital anomalies (11.1%, aOR = 1.9, 95% CI: 1.3-2.7), and who were hospitalized in the past year (13.3%, aOR = 1.8, 95% CI: 1.1-2.8) were more likely than their counterparts to have advance care directives. Individuals aged 19-24 years (6.6%, aOR = 0.4, 95% CI: 0.3-0.7) and 25-30 years (7.6%, aOR = 0.5, 95% CI: 0.3-0.8), compared to 31-38 years (14.3%), and non-Hispanic blacks (2.5%), compared to non-Hispanic whites (9.5%, aOR = 0.2, 95% CI: 0.1-0.6), were less likely to have advance care directives. Few young adults with CHD had advance care directives. Disparities in advance care planning may exist.
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Affiliation(s)
- Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS 106-3, Atlanta, GA, 30341, USA.
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS 106-3, Atlanta, GA, 30341, USA
| | - Anthony Goudie
- Department of Pediatrics, Center for Applied Research and Evaluation, College of Medicine, Little Rock, AR, USA
| | - Scott E Klewer
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
| | | | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS 106-3, Atlanta, GA, 30341, USA
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
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Downing KF, Oster ME, Klewer SE, Rose CE, Nembhard WN, Andrews JG, Farr SL. Disability Among Young Adults With Congenital Heart Defects: Congenital Heart Survey to Recognize Outcomes, Needs, and Well-Being 2016-2019. J Am Heart Assoc 2021; 10:e022440. [PMID: 34666499 PMCID: PMC8751822 DOI: 10.1161/jaha.121.022440] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Disabilities have implications for health, well‐being, and health care, yet limited information is available on the percentage of adults with congenital heart defects (CHD) living with disabilities. We evaluated the prevalence of disability and associated characteristics among the 2016–2019 CH STRONG (Congenital Heart Survey to Recognize Outcomes, Needs, and Well‐Being) population‐based sample of 19‐ to 38‐year‐olds with CHD from 3 US locations. Methods and Results Prevalence of disability types (hearing, vision, cognition, mobility, self‐care, living independently) were compared with similarly aged adults from the general population as estimated by the American Community Survey and standardized to the CH STRONG eligible population to reduce nonresponse bias and confounding. Health‐related quality of life (HRQOL) was measured via Patient‐Reported Outcomes Measurement Information System Global Health Scale T‐scores standardized to US 18‐ to 34‐year‐olds. Separate multivariable regression models assessed associations between disability and HRQOL. Of 1478 participants, 40% reported disabilities, with cognition most prevalent (29%). Of those reporting disability, 45% ever received disability benefits and 46% were unemployed. Prevalence of disability types were 5 to 8 times higher in adults with CHD than the general population. Those with ≥1 disability had greater odds of being female, and of having non‐Hispanic Black maternal race and ethnicity, severe CHD, recent cardiac care, and noncardiac congenital anomalies. On average, adults with CHD and cognition, mobility, and self‐care disabilities had impaired mental HRQOL and those with any disability type had impaired physical HRQOL. Conclusions Two of 5 adults with CHD may have disabilities, which are associated with impaired HRQOL. These results may inform healthcare needs and services for this growing population.
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Affiliation(s)
- Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA.,Children's Healthcare of Atlanta and Emory University School of Medicine Atlanta GA
| | - Scott E Klewer
- Department of Pediatrics University of Arizona Tucson AZ
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | - Wendy N Nembhard
- Department of Epidemiology Fay W Boozman College of Public Health and the Arkansas Center for Birth Defects Research and Prevention University of Arkansas for Medical Sciences Little Rock AR
| | | | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
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Anderson BR, Dragan K, Crook S, Woo JL, Cook S, Hannan EL, Newburger JW, Jacobs M, Bacha EA, Vincent R, Nguyen K, Walsh-Spoonhower K, Mosca R, Devejian N, Kamenir SA, Alfieris GM, Swartz MF, Meyer D, Paul EA, Billings J. Improving Longitudinal Outcomes, Efficiency, and Equity in the Care of Patients With Congenital Heart Disease. J Am Coll Cardiol 2021; 78:1703-1713. [PMID: 34674815 DOI: 10.1016/j.jacc.2021.08.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/11/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Longitudinal follow-up, resource utilization, and health disparities are top congenital heart research and care priorities. Medicaid claims include longitudinal data on inpatient, outpatient, emergency, pharmacy, rehabilitation, home health utilization, and social determinants of health-including mother-infant pairs. OBJECTIVES The New York Congenital Heart Surgeons Collaborative for Longitudinal Outcomes and Utilization of Resources linked robust clinical details from locally held state and national registries from 10 of 11 New York congenital heart centers to Medicaid claims, building a novel, statewide mechanism for longitudinal assessment of outcomes, expenditures, and health inequities. METHODS The authors included all children <18 years of age undergoing cardiac surgery in The Society of Thoracic Surgeons Congenital Heart Surgery Database or the New York State Pediatric Congenital Cardiac Surgery Registry from 10 of 11 New York centers, 2006 to 2019. Data were linked via iterative, ranked deterministic matching on direct identifiers. Match rates were calculated and compared. Proportions of the linked cohort trackable over 3, 5, and 10 years were described. RESULTS Of 14,097 registry cases, 59% (n = 8,322) reported Medicaid use. Of these, 7,414 were linked to New York claims, at an 89% match rate. Of matched cases, the authors tracked 79%, 74%, and 65% of children over 3, 5, and 10 years when requiring near-continuous Medicaid enrollment. Allowing more lenient enrollment criteria, the authors tracked 86%, 82%, and 76%, respectively. Mortality over this time was 7.7%, 8.4%, and 10.0%, respectively. Manual validation revealed ∼100% true matches. CONCLUSIONS This establishes a novel statewide data resource for assessment of longitudinal outcome, health expenditure, and disparities for children with congenital heart disease.
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Affiliation(s)
- Brett R Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
| | - Kacie Dragan
- Wagner Graduate School of Public Service, New York University, New York, New York, USA
| | - Sarah Crook
- Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Joyce L Woo
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Stephen Cook
- Offices of Health Insurance Programs, New York State Department of Health, Albany, New York, USA
| | - Edward L Hannan
- School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Jane W Newburger
- Department of Pediatric Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Marshall Jacobs
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emile A Bacha
- Department of Cardiothoracic Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Weill Cornell Medical Center, New York, New York, USA
| | - Robert Vincent
- Division of Pediatric Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Khanh Nguyen
- Department of Cardiac Surgery, Westchester Medical Center, Valhalla, New York, USA
| | | | - Ralph Mosca
- Department of Cardiothoracic Surgery, New York University, New York, New York, USA
| | - Neil Devejian
- Division of Pediatric Cardiothoracic Surgery, Albany Medical College, Albany, New York, USA
| | - Steven A Kamenir
- Division of Pediatric Cardiology, Albany Medical College, Albany, New York, USA
| | - George M Alfieris
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA; Department of Surgery, State University of New York Upstate Medical Center, Syracuse, New York, USA
| | - Michael F Swartz
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - David Meyer
- Department of Cardiothoracic Surgery, Hofstra-Northwell School of Medicine, Uniondale, New York, USA; Department of Pediatrics, Hofstra-Northwell School of Medicine, Uniondale, New York, USA
| | - Erin A Paul
- Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Billings
- Wagner Graduate School of Public Service, New York University, New York, New York, USA
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Oster ME, Riser AP, Andrews JG, Bolin EH, Galindo MK, Nembhard WN, Rose CE, Farr SL. Comorbidities Among Young Adults with Congenital Heart Defects: Results from the Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG - Arizona, Arkansas, and Metropolitan Atlanta, 2016-2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:197-201. [PMID: 33571179 PMCID: PMC7877580 DOI: 10.15585/mmwr.mm7006a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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