title: Racial/Ethnic disparities in risk of early childhood mortality among children with congenital heart defects.
abstract: BACKGROUND
  Infants with congenital heart defects (CHDs) have increased risk of childhood morbidity and mortality. However, little is known about racial/ethnic differences in early childhood mortality.
  
  
  METHODS
  We conducted a retrospective cohort study with data from the Texas Birth Defect Registry on 19 530 singleton, live-born infants with a CHD and born January 1, 1996, to December 31, 2003, to non-Hispanic (NH) white, NH black, and Hispanic women. Texas Birth Defect Registry data were linked to Texas death records and the National Death Index to ascertain deaths between January 1, 1996, and December 31, 2005. Kaplan-Meier survival estimates were computed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated from multivariable Cox-proportional hazard regression models to determine the effect of maternal race/ethnicity on mortality for selected CHD phenotypes.
  
  
  RESULTS
  After adjusting for covariates, compared with NH white children, NH black children had increased early childhood mortality risk for transposition of the great arteries (HR: 2.04 [95% CI: 1.40-2.97]), tetralogy of Fallot (HR: 1.85 [95% CI: 1.09-3.12]), pulmonary valve atresia without ventricular septal defect (VSD) (HR: 2.60 [95% CI: 1.32-5.12]), VSD (HR: 1.56 [95% CI: 1.19-2.03]), and atrial septal defect (HR: 1.34 [95% CI: 1.08-1.66]). Hispanic children had higher mortality risk for pulmonary valve atresia without VSD (HR: 1.76 [95% CI: 1.06-2.91]) and hypoplastic left heart syndrome (HR: 1.51 [95% CI: 1.13-2.02]).
  
  
  CONCLUSIONS
  We provide evidence that supports racial/ethnic disparities in early childhood mortality among infants with CHDs. Identifying infants with the greatest risk of early childhood mortality will facilitate development of interventions and policies to mitigate these risks.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612-3805, USA. wnembha@health.usf.edu
authors.forename: Wendy N
authors.initials: WN
authors.lastname: Nembhard
authors.forename: Jason L
authors.initials: JL
authors.lastname: Salemi
authors.forename: Mary K
authors.initials: MK
authors.lastname: Ethen
authors.forename: David E
authors.initials: DE
authors.lastname: Fixler
authors.forename: Angela
authors.initials: A
authors.lastname: Dimaggio
authors.forename: Mark A
authors.initials: MA
authors.lastname: Canfield
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D002423:Cause of Death; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D044469:Racial Groups / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States; D044465:White People / Q000706:statistics & numerical data