Saturday 25 Oct 2014

Information and opinions presented here do not always represent the views of the American Heart Association.

Uninsured and black infants with severe heart defects face higher death risk

Published: 1:06 pm CDT, July 25, 2014

Among infants born with severe heart defects, uninsured newborns were three times more likely to die than privately insured newborns, according to a new study by the Centers for Disease Control and Prevention. Health insurance coverage helped explain differences in survival seen between black and white babies born with heart defects.

Researchers estimated the likelihood of death for more than 43,000 Florida infants born with heart defects between 1998 and 2007. They then looked at how the type of health insurance coverage affected the risk of death. Infants are considered newborns from birth to 28 days old.

Despite having a 70 percent lower risk of death as newborns, black infants with severe heart defects had twice the risk as privately insured infants when they were 29 days to 1 year old.

This lower survival may be due to the cost of medical care, difficulty families had in getting their infants to follow-up appointments and other family needs, according to researchers.

Other factors affecting survival may include the severity of the heart defect, how soon the defect was diagnosed, and changes to the type of insurance and insurance status over time.

“Although this study did not evaluate strategies to improve survival, better access to care might lead to improved health outcomes,” said James Kucik, PhD, MPH, health scientist, National Center on Birth Defects and Developmental Disabilities at the CDC in Atlanta, Georgia. “Babies born with [congenital heart defects] require high levels of specialized and timely care, so barriers to care need to be identified and addressed.”

Survival differences between privately and publicly insured infants with heart defects were only found among black infants. Although the difference in the risk of death for white and black babies dropped by 50 percent when researchers accounted for the type of health insurance they had, there were still survival differences.

Previous studies have found that racial and ethnic minorities tend to have worse health outcomes, as do people with little or no insurance, Kucik said.

“Differences in access to care accounted for more of the racial and ethnic disparities than other factors we looked at, such as maternal age, maternal education and birth weight,” Kucik said. “It is possible that hospital referral patterns also play a role – for instance, non-Hispanic blacks might be referred to hospitals with a record of higher mortality.”

For those with less severe heart defects, uninsured newborns had double the risk of death as privately-insured newborns.

The study was published online by the American Journal of Public Health.

About 36,000 children in the United States are born with a heart defect each year – at least nine of every 1,000 infants, according to the American Heart Association. The causes of heart defects  aren’t fully understood, although genetic syndromes, a single defective gene, or environmental factors during pregnancy may be to blame, according to researchers.

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