Association of Rurality With Mortality After Congenital Heart Surgery.

BACKGROUND

Disparities between metro and nonmetro areas exist in health outcomes. The effect of residing areas on mortality for patients with congenital heart disease remains unclear. We evaluated the relationship of residing areas with survival outcomes after congenital heart surgery (CHS).

METHODS

This is a retrospective cohort study of patients enrolled in the Pediatric Cardiac Care Consortium who had a history of CHS. Outcomes were tracked by the National Death Index through 2022. Logistic regression and Cox proportional hazards models were fitted to examine the associations between residence at CHS with in-hospital mortality and long-term survival after adjustment for covariates.

RESULTS

Among 28 504 eligible patients (47.0% female patients) with a history of CHS, 19 772 (69.4%) patients resided in metro areas. Patients with congenital heart disease living in nonmetro areas at CHS had a lower (86.5%) 30-year survival rate following discharge from initial CHS versus patients living in metro areas (88.4%). After adjustment for sex, birth era, congenital heart disease severity, and presence of chromosomal abnormality, residing in nonmetro areas was associated with an increased risk of long-term mortality (adjusted hazard ratio, 1.12 [95% CI, 1.03-1.21]). Further adjustment for the neighborhood socioeconomic status attenuated the observed reduction in risk of death between nonmetro and metro areas. Patients with mild congenital heart disease who resided in nonmetro and not adjacent to metro areas were independently associated with an increased risk of long-term death (adjusted hazard ratio, 1.34 [95% CI, 1.00-1.77]), after adjustment for covariates and neighborhood socioeconomic status.

CONCLUSIONS

Residence in nonmetro areas at CHS is associated with an increased risk of death both in the immediate postoperative period in-hospital and on the long-term up to 30 years after CHS discharge, but this association is explained by differential neighborhood socioeconomic status at the time of CHS. These findings provide opportunities for targeted interventions to reduce disparities and improve outcomes for all patients after CHS.