title: Effect of acculturation and distance from cardiac center on congenital heart disease mortality.
abstract: OBJECTIVE
  Despite improvements in congenital heart disease (CHD) survival over the past 4 decades, ethnic disparities persist. Several studies have shown higher postoperative CHD adjusted mortality in black and Hispanic children. Others noted that non-English-speaking language at home was associated with appointment noncompliance, which the parents attributed to misunderstanding and living too far from a health center. The purpose of this study was to determine the effect of home distance to a cardiac center, or having a Latin American-born parent, on first-year mortality in infants with severe CHD.
  
  
  METHODS
  Infants with severe CHD, having an estimated first-year mortality >25%, born 1996-2003, were identified from the Texas Birth Defects Registry and linked to state and national vital records. We examined the effects of defect type; birth weight; gestational age; extracardiac anomalies; infant gender; maternal race/ethnicity, marital status, and education; residence in a Texas county bordering Mexico; home distance to cardiac center; and parental birth country on first-year survival.
  
  
  RESULTS
  Overall first-year survival was 59.9%, and no race/ethnic differences were noted; however, survival was significantly (P < .05) lower for Hispanic infants with hypoplastic left heart syndrome. Neither home distance to a cardiac center nor parental birth country was related to first-year survival; however, survival was noted to be lower in Texas counties bordering Mexico, counties that have high rates of poverty.
  
  
  CONCLUSIONS
  Further studies are needed to determine if these disparities in survival of infants with severe CHD are attributable to delays in referral to a cardiac center.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA. david.fixler@childrens.com
authors.forename: David E
authors.initials: DE
authors.lastname: Fixler
authors.forename: Wendy N
authors.initials: WN
authors.lastname: Nembhard
authors.forename: Ping
authors.initials: P
authors.lastname: Xu
authors.forename: Mary K
authors.initials: MK
authors.lastname: Ethen
authors.forename: Mark A
authors.initials: MA
authors.lastname: Canfield
mesh_terms: D000046:Academic Medical Centers / Q000639:trends*; D000069:Acculturation; D002309:Cardiology / Q000639:trends*; D015331:Cohort Studies; D005006:Ethnicity / Q000208:ethnology; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006330:Heart Defects, Congenital / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011159:Population Surveillance / Q000379:methods; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000208:ethnology