O1013: Trend in racial differences in mortality attributed to Congenital Heart Diseases in infants in the United States from 2005 to 2019

Background: Deaths from congenital heart disease (CHD) in children have been decreasing. We examined the differences in CHD mortality trends between Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) infants in the United States from 2005 to 2019. We hypothesized that a disparity in mortality rates exists between NHB and NHW infants.

Methods: We performed a retrospective cross-sectional analysis of publicly available data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research. The data was obtained from the linked birth/infant deaths from 2005 to 2019. We evaluated all infant deaths up to 1 year of age with the cause of death listed as CHD (International classification of diseases, 10th revision (ICD-10) codes Q20-Q26 (except atrial septal defect, Q21.1 and patent ductus arteriosus, Q25. CHD infant mortality rate (IMR) was calculated per 100,000 live births. Race was ascertained based on death certificate reporting. Joinpoint regression was used to examine CHD-IMR by year, including stratification by NHB vs NHW. The difference between NHB and NHW CHD-IMR was ascertained via the Mann-Whitney U test. P< 0.05 was considered statistically significant.

Results: Out of 60,243,988 live births, there were 19,004 CHD-related infant deaths. The characteristics of the study population are displayed in Table 1. The overall CHD-IMR declined from 36.1 to 27.0 per 100,000 live births (25.2%) with an average annual percentage change (AAPC) of -2.1 [95% confidence interval (CI)-2.6, -1.572] (Figure 1). The CHD-IMR was significantly higher in NHB than in NHW (40 vs 29.3; P< 0.0001) and this difference remained when the CHD mortality rate was stratified by the neonatal and post-neonatal period. The CHD-IMR decreased significantly in NHW [AAPC: -2%; 95% CI: -2.5, -1.5%], however, it was not significant in NHB [AAPC of -1.4%, 95% CI, -3.0, 0.3%]. The NHB-to-NHW CHD-IMR ratio, a measure of CHD-IMR disparity averaged 1.4 and there was no significant change during the study period [AAPC: 0.8%; 95% CI: -0.2, 1.8%] (Figure 2).

Conclusion: The CHD-IMR declined significantly for NHW, but not in NHB in the US from 2005 to 2019. The CHD-IMR was significantly higher in NHB than in NHW. There was no significant change in the NHB-to-NHW CHD-IMR ratio, signifying no change in the disparity that exists between NHB and NHW IMR. These findings may have implications for patient care and public health policymaking. They lay the groundwork for additional studies to determine and understand the drivers behind these findings such as in prenatal diagnosis.