Comorbidities in Adolescents With Congenital Heart Disease: A Population-based Study.

OBJECTIVES

We evaluated the frequency and patterns of comorbidity and multimorbidity in adolescents with congenital heart disease (CHD) using data from a multisite population-based surveillance project.

METHODS

Adolescents aged 11 to 18 years with at least 1 CHD-related diagnosis code and residing in one of 5 geographic areas in the US were identified using linked clinical and administrative data sources for the years 2011 to 2013. Sites linked data on all inpatient, emergency department, and outpatient visits. Multivariate Poisson regression with robust error estimates was used to assess the association of comorbidity with age, sex, insurance type, race, ethnicity, and CHD severity.

RESULTS

The study included 9626 adolescents. Of these, 26% had severe CHDs. Overall, 68% had at least one comorbidity during the study period, and 46% had multiple comorbidities. Noncardiac comorbidities (55%) were more frequent than cardiac comorbidities (40%). Major noncardiac comorbidities included mental health conditions, neurodevelopmental disorders, pulmonary obstructive disease, nutrition-related (overweight, obesity) conditions, and endocrine conditions. Cardiac comorbidities included arrhythmias and residual cardiac disease. Variations by age and sex were minimal, but a higher burden of comorbidity and multimorbidity was associated with CHD severity, multiracial background, and public insurance.

CONCLUSIONS

Comorbidities, both cardiac and noncardiac, are prevalent in adolescents with CHD, underscoring the need for targeted care strategies in this age group and effective transition programs from pediatric to adult CHD care.