Associations Between Socioeconomic Status and Adult Congenital Heart Disease Mortality in the United States: Insights From the Global Burden of Disease Study.

BACKGROUND

The GBD (Global Burden of Disease) study provides a unique opportunity to better understand the socioeconomic and geographical drivers of clinical outcomes and mortality in adult congenital heart disease (ACHD) in the United States.

METHODS

We performed a secondary data analysis using a population-based observational study design that studied state specific data on mortality and disability-adjusted life years from 1990 to 2021 for patients with ACHD aged 20 years and older in the United States. These data were acquired from the GBD study. We subsequently correlated these data with median household income and percentage of uninsured people in each state by using the US census bureau poverty and income data.

RESULTS

In 2021, the GBD study identified 292 624 (95% CI, 258 956-342 906) adults ≥20 years with CHD living in the United States with 1074 (95% CI, 964-1331) ACHD related deaths and 62 244 (95% CI, 51 820-76 301) disability-adjusted life years. The state with the highest mortality and disability-adjusted life years (West Virginia) also has one of the lowest median household incomes ($51 122). States with lower ACHD related mortality have higher median household incomes (r2=0.62, P < 0.001). There is a lower correlation between mortality and the percentage of patients uninsured in each state (r2=0.14, P=0.0068).

CONCLUSIONS

The GBD study provides unique insight into ACHD mortality and disability in the United States. Although mortality and disability rates have decreased from 1990 to 2021, patients with ACHD living in states with lower median household income and higher percentage of uninsured people have higher rates of mortality and disability. Ensuring adequate access to specialized care is warranted for this population.