ociodemographic Factors and Survival of Infants With Congenital Heart Defects
ociodemographic Factors and Survival of Infants With Congenital Heart Defects
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DOI：
10.1542/peds.2018-0302
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发表时间：
2018-09-01
期刊：
影响因子：
8
通讯作者：
Meyer, Robert E.
中科院分区：
文献类型：
--
作者：
Pace, Nelson D.;Oster, Matthew E.;Meyer, Robert E.
目的：研究先天性心脏病（CHD）婴儿的第一年生存率，并探讨社会经济和人口统计学因素对survival.METHODS的潜在作用：受试者包括15533名出生于2004年和2013年之间的先天性心脏病婴儿NC出生缺陷监测计划确定。我们将CHD分为以下3组：临界单心室（n = 575），临界双心室（n = 1494）和非临界双心室（n = 13345）。我们通过与州生命记录的联系确定了生命状态和死亡年龄，并使用出生时的地理编码母亲居住地来获得研究对象的人口普查信息。我们计算Kaplan-Meier生存估计的母亲和婴儿的特点和风险比从考克斯比例风险模型为选定的exposition.RESULTS：在所有的婴儿CHD，有1289例死亡（8.3%）在第一年。在单心室缺陷的婴儿中，61.6%（95%置信区间[CI]：57.7%-65.7%）存活。父亲年龄35岁（71.6%; 95% CI：63.8%-80.3%）的单心室缺陷婴儿的存活率明显高于父亲年龄更小（59.7%; 95% CI：54.6%-65.2%）的婴儿。与任何双心室缺陷婴儿存活率相关的因素包括母亲教育、种族和/或民族、婚姻状况和在心脏中心分娩。婴儿死亡率的危险是最大的非西班牙裔非洲裔美国mothers.CONCLUSIONS：婴儿与关键单心室心脏病的生存率之间的差异较小的社会人口学类别相比，婴儿与双心室心脏病的生存。社会人口统计学上的差异，在婴儿的生存与不太严重的心脏病加强的重要性，确保文化有效的儿科护理的风险婴儿及其家庭。
OBJECTIVES: To examine the first-year survival of infants with congenital heart defects (CHDs) and investigate the potential role of socioeconomic and demographic factors on survival.METHODS: Subjects included 15533 infants with CHDs born between 2004 and 2013 ascertained by the NC Birth Defects Monitoring Program. We classified CHDs into the following 3 groups: critical univentricular (n = 575), critical biventricular (n = 1494), and noncritical biventricular (n = 13345). We determined vital status and age at death through linkage to state vital records and used geocoded maternal residence at birth to obtain census information for study subjects. We calculated Kaplan-Meier survival estimates by maternal and infant characteristics and derived hazard ratios from Cox proportional hazard models for selected exposures.RESULTS: Among all infants with CHDs, there were 1289 deaths (8.3%) in the first year. Among infants with univentricular defects, 61.6% (95% confidence interval [CI]: 57.7%-65.7%) survived. Survival among infants with univentricular defects was considerably better for those whose fathers were 35 years old (71.6%; 95% CI: 63.8%-80.3%) compared with those whose fathers were younger (59.7%; 95% CI: 54.6%-65.2%). Factors associated with survival among infants with any biventricular defect included maternal education, race and/or ethnicity, marital status, and delivery at a heart center. The hazard of infant mortality was greatest among non-Hispanic African American mothers.CONCLUSIONS: Survival among infants with critical univentricular CHDs was less variable across sociodemographic categories compared with survival among infants with biventricular CHDs. Sociodemographic differences in survival among infants with less severe CHDs reinforces the importance of ensuring culturally effective pediatric care for at-risk infants and their families.