title: Life insurance and mortgage application in adults with congenital heart disease.
abstract: OBJECTIVE
  To compare the outcome of life insurance and mortgage applications of adults with congenital heart disease (CHD) with controls and at different severities of CHD.
  
  
  METHODS
  Two hundred and ninety-nine adult CHD patients underwent a questionnaire-based interview by a trained nurse. They were asked to give an identical questionnaire to a friend to act as a control. One hundred and seventy-seven controls replied. CHD patients were classified into three categories based on severity. Comparisons were made between matched controls and between different severities of CHD.
  
  
  RESULTS
  Similar proportions of the CHD group (59%) had applied for life insurance as matched controls (56%). Compared to controls, significantly more of the adults with CHD who had applied for life insurance have been refused (34 vs 4%, P < 0.0001) or asked to pay extra (37 vs 6%, P = 0.0002). Mortgage application rate was also similar in both groups with more of the CHD patients refused than matched controls (20 vs 3%, P = 0.0004). These differences in both life insurance and mortgage remain significant when the cases and controls are matched by employment status and NYHA functional class. There was no significant difference in life insurance and mortgage application outcome between the groups of mild, significant and complex CHD.
  
  
  CONCLUSIONS
  Adults with CHD are significantly more likely to have difficulty obtaining life insurance or a mortgage than controls. Refusal rates appear to be independent of the severity of CHD. This suggests that the label of CHD may have a negative impact despite the lesion being minor and that the outcome of an individual application is difficult to predict based on the severity of the CHD. The increasing numbers of adults with CHD suggest that this problem is likely to increase and needs to be addressed as it can have a major impact on the patient's quality of life.
authors.affiliation: Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK. davidxland@hotmail.com
authors.forename: D S
authors.initials: DS
authors.lastname: Crossland
authors.forename: S P
authors.initials: SP
authors.lastname: Jackson
authors.forename: R
authors.initials: R
authors.lastname: Lyall
authors.forename: J R L
authors.initials: JR
authors.lastname: Hamilton
authors.forename: A
authors.initials: A
authors.lastname: Hasan
authors.forename: J
authors.initials: J
authors.lastname: Burn
authors.forename: J J
authors.initials: JJ
authors.lastname: O'Sullivan
mesh_terms: D000328:Adult; D017281:Cost of Illness; D005260:Female; D006330:Heart Defects, Congenital / Q000534:rehabilitation*; D006798:Housing / Q000191:economics*; D006801:Humans; D007352:Insurance, Life; D008297:Male; D016555:Matched-Pair Analysis; D012720:Severity of Illness Index; D012959:Socioeconomic Factors