Neighborhood-level socioeconomic position and mortality among children born with critical congenital heart defects.

We examined the role of neighborhood-level socioeconomic position (nSEP) in 1- and 5-year survival among children with critical congenital heart defects (CCHDs). Children with CCHDs in the National Birth Defects Prevention Study (1999-2011) were grouped into univentricular and biventricular defects and linked to vital records for 1- and 5-year mortality. The Neighborhood Deprivation Index (NDI) was used to classify census-tract nSEP (low [referent], moderate, high deprivation) using maternal periconceptional address. Kaplan-Meier survival curves and log-rank tests were used to evaluate survival differences. Cox proportional hazards regression models were used to estimate crude and adjusted hazard ratios and 95% confidence intervals, adjusting for birth years, maternal sociodemographic factors, and residential mobility. Among 2459 children with CCHDs, 1 year survival curves differed by neighborhood deprivation. Survival was lowest among children of mothers living in high- vs low-deprivation neighborhoods. In crude analyses, high deprivation was associated with higher 1-year mortality (all CCHDs: 1.58 [1.17, 2.13]; univentricular CCHDs: 1.50 [0.99, 2.26]; biventricular CCHDs: 1.64 [1.02, 2.64]). After adjustment, estimates were generally attenuated and less precise. Five-year survival showed similar trends. Further research could inform strategies to address the structural, environmental, and/or physiological factors associated with a potential reduced survival among children with CCHDs born to mothers in socioeconomically deprived areas.