Yang Yanxu, Huang Yijian, Knight Jessica H, Oster Matthew E, Kochilas Lazaros K
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (Y.Y., M.E.O., L.K.K.).
Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, GA (Y.H.).
Circ Cardiovasc Qual Outcomes. 2025 Jun;18(6):e011708. doi: 10.1161/CIRCOUTCOMES.124.011708. Epub 2025 May 13.
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).
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.
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.
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.
城市和非城市地区在健康结果方面存在差异。居住地区对先天性心脏病患者死亡率的影响尚不清楚。我们评估了居住地区与先天性心脏病手术（CHS）后生存结果之间的关系。
这是一项对参加儿科心脏护理联盟且有CHS病史患者的回顾性队列研究。通过国家死亡指数追踪至2022年的结果。拟合逻辑回归和Cox比例风险模型，以检验在调整协变量后CHS时的居住地与住院死亡率和长期生存之间的关联。
在28504名有CHS病史的合格患者中（47.0%为女性患者），19772名（69.4%）患者居住在城市地区。与居住在城市地区的患者相比，CHS时居住在非城市地区的先天性心脏病患者在首次CHS出院后的30年生存率较低（86.5%）。在调整性别、出生年代、先天性心脏病严重程度和染色体异常情况后，居住在非城市地区与长期死亡风险增加相关（调整后的风险比，1.12[95%CI，1.03 - 1.21]）。进一步调整邻里社会经济地位减弱了观察到的非城市和城市地区之间死亡风险的降低。在调整协变量和邻里社会经济地位后，居住在非城市且不邻近城市地区的轻度先天性心脏病患者与长期死亡风险增加独立相关（调整后的风险比，1.34[95%CI，1.00 - 1.77]）。
CHS时居住在非城市地区与术后早期住院期间以及CHS出院后长达30年的长期死亡风险增加相关，但这种关联可由CHS时不同的邻里社会经济地位来解释。这些发现为采取有针对性的干预措施以减少差异并改善所有CHS患者的结局提供了机会。
