title: Racial/ethnic disparities in timing of death during childhood among children with congenital heart defects.
abstract: BACKGROUND
  Infants with congenital heart defects (CHD) have increased risk of morbidity and mortality. Little is known about racial/ethnic differences in timing of death during childhood. Our intent was to investigate racial/ethnic differences in mortality for CHDs during specific time periods in childhood.
  
  
  METHODS
  Texas Birth Defect Registry data were used for a retrospective cohort study with 30,015 singleton infants with a CHD, born January 1, 1999, to December 31, 2007, to non-Hispanic (NH) white, NH-black, or Hispanic women. Texas Birth Defect Registry data were linked to Texas death records to ascertain death. Kaplan-Meier survival probabilities and multivariable Cox-proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated.
  
  
  RESULTS
  NH-blacks and Hispanics with specific CHDs had increased mortality during the postneonatal period and early childhood. NH-blacks had increased postneonatal mortality compared with NH-whites for transposition of the great arteries (HR = 2.4; 95% CI, 1.5-4.0), pulmonary valve atresia without ventricular septal defect (HR = 4.1; 95% CI, 1.7-9.7), Ebstein's anomaly (HR = 8.6; 95 CI, 1.2-61.1), hypoplastic left heart syndrome (HR = 2.1; 95% CI, 1.2-3.7), coarctation of the aorta (HR = 2.1; 95% CI, 1.2-3.5), ventricular septal defect (HR = 2.1; 95% CI, 1.6-2.8), and atrial septal defect (HR = 1.4; 95% CI, 1.1-1.8). Hispanics had increased postneonatal mortality risk for tetralogy of Fallot (HR = 2.0; 95% CI, 1.1-3.5). Racial/ethnic increases in mortality risk were also observed during infancy and childhood.
  
  
  CONCLUSIONS
  Racial/ethnic differences in mortality were most notably observed during the postneonatal period and early childhood. Future studies should assess factors associated with this disparity in mortality risk for infants with CHDs.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida.
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: David E
authors.initials: DE
authors.lastname: Fixler
authors.forename: Jason L
authors.initials: JL
authors.lastname: Salemi
authors.forename: Mark A
authors.initials: MA
authors.lastname: Canfield
mesh_terms: D000328:Adult; D001741:Black or African American; D002648:Child; D002675:Child, Preschool; D005260:Female; D054624:Health Status Disparities; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality*; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D062486:Public Health Surveillance; D012042:Registries; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D044465:White People
keywords: childhood; congenital heart defects; ethnicity; infant; mortality; race; survival