Socioeconomic inequalities in mortality in children with congenital heart disease

a systematic review and meta-analysis

Kate E Best (Corresponding Author), Rute Vieira, Svetlana V Glinianaia, Judith Rankin

Research output: Contribution to journalReview article

Abstract

Background
The impact of socio‐economic status (SES) on congenital heart disease (CHD)‐related mortality in children is not well established.

Objectives
We aimed to systematically review and appraise the existing evidence on the association between SES (including poverty, parental education, health insurance, and income) and mortality among children with CHD.

Data sources
Seven electronic databases (Medline, Embase, Scopus, PsycINFO, CINAHL, ProQuest Natural, and Biological Science Collections), reference lists, citations, and key journals were searched.

Study selection and data extraction
We included articles reporting original research on the association between SES and mortality in children with CHD if they were full papers published in the English language and regardless of (a) timing of mortality; (b) individual or area‐based measures of SES; (c) CHD subtype; (d) age at ascertainment; (e) study period examined. Screening for eligibility, data extraction, and quality appraisal were performed in duplicate.

Synthesis
Meta‐analyses were performed to estimate pooled ORs for in‐hospital mortality according to health insurance status.

Results
Of 1388 identified articles, 28 met the inclusion criteria. Increased area‐based poverty was associated with increased odds/risk of postoperative (n = 1), neonatal (n = 1), post‐discharge (n = 1), infant (n = 1), and long‐term mortality (n = 2). Higher parental education was associated with decreased odds/risk of neonatal (n = 1) and infant mortality (n = 5), but not with long‐term mortality (n = 1). A meta‐analysis of four US articles showed increased unadjusted odds of in‐hospital mortality in those with government/public versus private health insurance (OR 1.40, 95% CI 1.24, 1.56). The association between area‐based income and CHD‐related mortality was conflicting, with three of eight articles reporting significant associations.

Conclusion
This systematic review provides evidence that children of lower SES are at increased risk of CHD‐related mortality. As these children are over‐represented in the CHD population, interventions targeting socio‐economic inequalities could have a large impact on improving CHD survival.
Original languageEnglish
Pages (from-to)291-309
Number of pages19
JournalPaediatric and Perinatal Epidemiology
Volume33
Issue number4
Early online date26 Jul 2019
DOIs
Publication statusPublished - 26 Jul 2019

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Child Mortality
Meta-Analysis
Heart Diseases
Social Class
Health Insurance
Mortality
Poverty
Hospital Mortality
Natural Science Disciplines
Education
Insurance Coverage
Biological Science Disciplines
Infant Mortality
Health Status
Language
Databases
Research
Population

Keywords

  • congenital heart defects
  • mortality
  • poverty
  • socioeconomic deprivation
  • survival
  • systematic review

Cite this

Socioeconomic inequalities in mortality in children with congenital heart disease : a systematic review and meta-analysis. / Best, Kate E (Corresponding Author); Vieira, Rute; Glinianaia, Svetlana V ; Rankin, Judith.

In: Paediatric and Perinatal Epidemiology, Vol. 33, No. 4, 26.07.2019, p. 291-309.

Research output: Contribution to journalReview article

@article{a1850423145347f6b831467f87e866ee,
title = "Socioeconomic inequalities in mortality in children with congenital heart disease: a systematic review and meta-analysis",
abstract = "BackgroundThe impact of socio‐economic status (SES) on congenital heart disease (CHD)‐related mortality in children is not well established.ObjectivesWe aimed to systematically review and appraise the existing evidence on the association between SES (including poverty, parental education, health insurance, and income) and mortality among children with CHD.Data sourcesSeven electronic databases (Medline, Embase, Scopus, PsycINFO, CINAHL, ProQuest Natural, and Biological Science Collections), reference lists, citations, and key journals were searched.Study selection and data extractionWe included articles reporting original research on the association between SES and mortality in children with CHD if they were full papers published in the English language and regardless of (a) timing of mortality; (b) individual or area‐based measures of SES; (c) CHD subtype; (d) age at ascertainment; (e) study period examined. Screening for eligibility, data extraction, and quality appraisal were performed in duplicate.SynthesisMeta‐analyses were performed to estimate pooled ORs for in‐hospital mortality according to health insurance status.ResultsOf 1388 identified articles, 28 met the inclusion criteria. Increased area‐based poverty was associated with increased odds/risk of postoperative (n = 1), neonatal (n = 1), post‐discharge (n = 1), infant (n = 1), and long‐term mortality (n = 2). Higher parental education was associated with decreased odds/risk of neonatal (n = 1) and infant mortality (n = 5), but not with long‐term mortality (n = 1). A meta‐analysis of four US articles showed increased unadjusted odds of in‐hospital mortality in those with government/public versus private health insurance (OR 1.40, 95{\%} CI 1.24, 1.56). The association between area‐based income and CHD‐related mortality was conflicting, with three of eight articles reporting significant associations.ConclusionThis systematic review provides evidence that children of lower SES are at increased risk of CHD‐related mortality. As these children are over‐represented in the CHD population, interventions targeting socio‐economic inequalities could have a large impact on improving CHD survival.",
keywords = "congenital heart defects, mortality, poverty, socioeconomic deprivation, survival, systematic review",
author = "Best, {Kate E} and Rute Vieira and Glinianaia, {Svetlana V} and Judith Rankin",
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T1 - Socioeconomic inequalities in mortality in children with congenital heart disease

T2 - a systematic review and meta-analysis

AU - Best, Kate E

AU - Vieira, Rute

AU - Glinianaia, Svetlana V

AU - Rankin, Judith

N1 - Funding Information: Newcastle University Medical Faculty Fellowship

PY - 2019/7/26

Y1 - 2019/7/26

N2 - BackgroundThe impact of socio‐economic status (SES) on congenital heart disease (CHD)‐related mortality in children is not well established.ObjectivesWe aimed to systematically review and appraise the existing evidence on the association between SES (including poverty, parental education, health insurance, and income) and mortality among children with CHD.Data sourcesSeven electronic databases (Medline, Embase, Scopus, PsycINFO, CINAHL, ProQuest Natural, and Biological Science Collections), reference lists, citations, and key journals were searched.Study selection and data extractionWe included articles reporting original research on the association between SES and mortality in children with CHD if they were full papers published in the English language and regardless of (a) timing of mortality; (b) individual or area‐based measures of SES; (c) CHD subtype; (d) age at ascertainment; (e) study period examined. Screening for eligibility, data extraction, and quality appraisal were performed in duplicate.SynthesisMeta‐analyses were performed to estimate pooled ORs for in‐hospital mortality according to health insurance status.ResultsOf 1388 identified articles, 28 met the inclusion criteria. Increased area‐based poverty was associated with increased odds/risk of postoperative (n = 1), neonatal (n = 1), post‐discharge (n = 1), infant (n = 1), and long‐term mortality (n = 2). Higher parental education was associated with decreased odds/risk of neonatal (n = 1) and infant mortality (n = 5), but not with long‐term mortality (n = 1). A meta‐analysis of four US articles showed increased unadjusted odds of in‐hospital mortality in those with government/public versus private health insurance (OR 1.40, 95% CI 1.24, 1.56). The association between area‐based income and CHD‐related mortality was conflicting, with three of eight articles reporting significant associations.ConclusionThis systematic review provides evidence that children of lower SES are at increased risk of CHD‐related mortality. As these children are over‐represented in the CHD population, interventions targeting socio‐economic inequalities could have a large impact on improving CHD survival.

AB - BackgroundThe impact of socio‐economic status (SES) on congenital heart disease (CHD)‐related mortality in children is not well established.ObjectivesWe aimed to systematically review and appraise the existing evidence on the association between SES (including poverty, parental education, health insurance, and income) and mortality among children with CHD.Data sourcesSeven electronic databases (Medline, Embase, Scopus, PsycINFO, CINAHL, ProQuest Natural, and Biological Science Collections), reference lists, citations, and key journals were searched.Study selection and data extractionWe included articles reporting original research on the association between SES and mortality in children with CHD if they were full papers published in the English language and regardless of (a) timing of mortality; (b) individual or area‐based measures of SES; (c) CHD subtype; (d) age at ascertainment; (e) study period examined. Screening for eligibility, data extraction, and quality appraisal were performed in duplicate.SynthesisMeta‐analyses were performed to estimate pooled ORs for in‐hospital mortality according to health insurance status.ResultsOf 1388 identified articles, 28 met the inclusion criteria. Increased area‐based poverty was associated with increased odds/risk of postoperative (n = 1), neonatal (n = 1), post‐discharge (n = 1), infant (n = 1), and long‐term mortality (n = 2). Higher parental education was associated with decreased odds/risk of neonatal (n = 1) and infant mortality (n = 5), but not with long‐term mortality (n = 1). A meta‐analysis of four US articles showed increased unadjusted odds of in‐hospital mortality in those with government/public versus private health insurance (OR 1.40, 95% CI 1.24, 1.56). The association between area‐based income and CHD‐related mortality was conflicting, with three of eight articles reporting significant associations.ConclusionThis systematic review provides evidence that children of lower SES are at increased risk of CHD‐related mortality. As these children are over‐represented in the CHD population, interventions targeting socio‐economic inequalities could have a large impact on improving CHD survival.

KW - congenital heart defects

KW - mortality

KW - poverty

KW - socioeconomic deprivation

KW - survival

KW - systematic review

UR - https://onlinelibrary.wiley.com/doi/abs/10.1111/ppe.12564

UR - http://www.mendeley.com/research/socioeconomic-inequalities-mortality-children-congenital-heart-disease-systematic-review-metaanalysi

U2 - 10.1111/ppe.12564

DO - 10.1111/ppe.12564

M3 - Review article

VL - 33

SP - 291

EP - 309

JO - Paediatric and Perinatal Epidemiology

JF - Paediatric and Perinatal Epidemiology

SN - 0269-5022

IS - 4

ER -