Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH; Department of Clinical Epidemiology, University of Aarhus, Aarhus, Denmark.
Heart Center at the Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
Am J Cardiol. 2020 Nov 15;135:135-142. doi: 10.1016/j.amjcard.2020.08.035. Epub 2020 Aug 28.
Among children with congenital heart disease (CHD), there is often neurodevelopmental and behavioral impairment with unclear implications regarding adult socioeconomic achievements. We aimed to compare economic self-sufficiency and educational attainment in CHD adults with sibling and general population controls. Using Danish population-based nationwide registries, this cohort study aimed to include all CHD subjects greater than 13 years born between 1963 and 1993. Comparison cohorts included: (1) sibling cohort and (2) general population cohort matched 10:1 on birth year and gender. We computed cumulative incidences of time to first full year of economic self-sufficiency, as well as educational attainment. We assessed the relative probability of self-sufficiency in all cohorts before 30 years of age, defined by Statistics Denmark federal standard. In total, we identified 7,019 CHD subjects, 6,257 full siblings, and 68,805 general population controls. The cumulative incidence of self-sufficiency by age 20 and 35 years for CHD subjects (49% and 84%, respectively) was lower than sibling (68% and 96%) and general population cohorts (67% and 95%). The relative probability of self-sufficiency for CHD subjects compared with siblings was 0.44 (95% confidence interval 0.39 to 0.49). By age 30, adults with CHD were less likely than their siblings to attain all levels of education. Among those achieving higher educational milestones, differences in self-sufficiency between cohorts were absent by age 35. In conclusion, CHD is associated with reduced adult economic self-sufficiency, and the relation between educational level attained and self-sufficiency may suggest that targeted interventions have the potential to improve adult self-sufficiency.
在患有先天性心脏病 (CHD) 的儿童中，常常存在神经发育和行为障碍，这对成人的社会经济成就有着尚不清楚的影响。我们旨在比较 CHD 成年患者与兄弟姐妹和一般人群对照者的经济自给能力和教育程度。本队列研究使用丹麦基于人群的全国性登记处，旨在纳入所有 1963 年至 1993 年出生的年龄大于 13 岁的 CHD 患者。比较队列包括：（1）兄弟姐妹队列和（2）按出生年份和性别以 10:1 比例匹配的一般人群队列。我们计算了首次实现完全经济自给所需时间的累积发生率，以及教育程度。我们评估了所有队列在 30 岁之前实现自给自足的相对可能性，这是由丹麦统计局联邦标准定义的。总共，我们确定了 7019 名 CHD 患者、6257 名同胞和 68805 名一般人群对照者。CHD 患者达到 20 岁和 35 岁时的自给自足的累积发生率（分别为 49%和 84%）低于同胞（分别为 68%和 96%）和一般人群队列（分别为 67%和 95%）。CHD 患者与同胞相比，实现自给自足的相对可能性为 0.44（95%置信区间 0.39 至 0.49）。到 30 岁时，与他们的兄弟姐妹相比，患有 CHD 的成年人更不可能获得所有教育水平。在达到更高教育里程碑的人群中，到 35 岁时，各队列之间在自给自足方面的差异不复存在。总之，CHD 与成年后经济自给能力降低有关，而达到的教育水平与自给自足之间的关系表明，有针对性的干预措施有可能提高成年人的自给自足能力。
