社会经济地位、种族和地理位置对左心发育不良综合征和大动脉转位产前检出的影响。
Impact of Socioeconomic Status, Race and Ethnicity, and Geography on Prenatal Detection of Hypoplastic Left Heart Syndrome and Transposition of the Great Arteries.
机构信息
Divisions of Cardiology (A.K., M.T.D.), Children's National Hospital, Washington, DC.
Biostatistics (M.B.J.), Children's National Hospital, Washington, DC.
出版信息
Circulation. 2021 May 25;143(21):2049-2060. doi: 10.1161/CIRCULATIONAHA.120.053062. Epub 2021 May 17.
BACKGROUND
Prenatal detection (PND) has benefits for infants with hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA), but associations between sociodemographic and geographic factors with PND have not been sufficiently explored. This study evaluated whether socioeconomic quartile (SEQ), public insurance, race and ethnicity, rural residence, and distance of residence (distance and driving time from a cardiac surgical center) are associated with the PND or timing of PND, with a secondary aim to analyze differences between the United States and Canada.
METHODS
In this retrospective cohort study, fetuses and infants <2 months of age with HLHS or TGA admitted between 2012 and 2016 to participating Fetal Heart Society Research Collaborative institutions in the United States and Canada were included. SEQ, rural residence, and distance of residence were derived using maternal census tract from the maternal address at first visit. Subjects were assigned a SEQ score using the neighborhood summary score or Canadian Chan index and separated into quartiles. Insurance type and self-reported race and ethnicity were obtained from medical charts. We evaluated associations among SEQ, insurance type, race and ethnicity, rural residence, and distance of residence with PND of HLHS and TGA (aggregate and individually) using bivariate analysis with adjusted associations for confounding variables and cluster analysis for centers.
RESULTS
Data on 1862 subjects (HLHS: n=1171, 92% PND; TGA: n=691, 58% PND) were submitted by 21 centers (19 in the United States). In the United States, lower SEQ was associated with lower PND in HLHS and TGA, with the strongest association in the lower SEQ of pregnancies with fetal TGA (quartile 1, 0.78 [95% CI, 0.64-0.85], quartile 2, 0.77 [95% CI, 0.64-0.93], quartile 3, 0.83 [95% CI, 0.69-1.00], quartile 4, reference). Hispanic ethnicity (relative risk, 0.85 [95% CI, 0.72-0.99]) and rural residence (relative risk, 0.78 [95% CI, 0.64-0.95]) were also associated with lower PND in TGA. Lower SEQ was associated with later PND overall; in the United States, rural residence and public insurance were also associated with later PND.
CONCLUSIONS
We demonstrate that lower SEQ, Hispanic ethnicity, and rural residence are associated with decreased PND for TGA, with lower SEQ also being associated with decreased PND for HLHS. Future work to increase PND should be considered in these specific populations.
背景
产前检测（PND）对患有左心发育不全综合征（HLHS）和大动脉转位（TGA）的婴儿有益，但社会人口和地理因素与 PND 之间的关联尚未得到充分探讨。本研究评估了社会经济四分位（SEQ）、公共保险、种族和民族、农村居民以及居住距离（与心脏外科中心的距离和驾驶时间）是否与 PND 或 PND 的时间有关，次要目的是分析美国和加拿大之间的差异。
方法
在这项回顾性队列研究中，纳入了 2012 年至 2016 年期间在美国和加拿大参与胎儿心脏协会研究合作机构接受治疗的患有 HLHS 或 TGA 的胎儿和 2 个月以下的婴儿。SEQ、农村居民和居住距离是根据母亲首次就诊时的母亲住址从母亲的人口普查区得出的。使用邻里综合评分或加拿大 Chan 指数为受试者分配 SEQ 评分，并将其分为四分位数。保险类型和自我报告的种族和民族从病历中获得。我们使用单变量分析评估了 SEQ、保险类型、种族和民族、农村居民和居住距离与 HLHS 和 TGA 的 PND（总体和个体）之间的关联，并使用混杂因素的调整关联和中心的聚类分析进行了评估。
结果
21 个中心（美国 19 个）提交了 1862 名受试者（HLHS：n=1171，92%PND；TGA：n=691，58%PND）的数据。在美国，较低的 SEQ 与 HLHS 和 TGA 的较低 PND 相关，在胎儿 TGA 妊娠的较低 SEQ 中关联最强（四分位 1，0.78[95%CI，0.64-0.85]，四分位 2，0.77[95%CI，0.64-0.93]，四分位 3，0.83[95%CI，0.69-1.00]，四分位 4，参考）。西班牙裔（相对风险，0.85[95%CI，0.72-0.99]）和农村居民（相对风险，0.78[95%CI，0.64-0.95]）也与 TGA 中较低的 PND 相关。较低的 SEQ 与整体较低的 PND 相关；在美国，农村居民和公共保险也与较晚的 PND 相关。
结论
我们证明，较低的 SEQ、西班牙裔和农村居民与 TGA 中 PND 的减少有关，较低的 SEQ 也与 HLHS 中 PND 的减少有关。应考虑在这些特定人群中增加 PND。
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