title: Role of health insurance on the survival of infants with congenital heart defects.
abstract: OBJECTIVE
  We examined the association between health insurance and survival of infants with congenital heart defects (CHDs), and whether medical insurance type contributed to racial/ethnic disparities in survival.
  
  
  METHODS
  We conducted a population-based, retrospective study on a cohort of Florida resident infants born with CHDs between 1998 and 2007. We estimated neonatal, post-neonatal, and infant survival probabilities and adjusted hazard ratios (AHRs) for individual characteristics.
  
  
  RESULTS
  Uninsured infants with critical CHDs had 3 times the mortality risk (AHR = 3.0; 95% confidence interval = 1.3, 6.9) than that in privately insured infants. Publicly insured infants had a 30% reduced mortality risk than that of privately insured infants during the neonatal period, but had a 30% increased risk in the post-neonatal period. Adjusting for insurance type reduced the Black-White disparity in mortality risk by 50%.
  
  
  CONCLUSIONS
  Racial/ethnic disparities in survival were attenuated significantly, but not eliminated, by adjusting for payer status.
authors.affiliation: James E. Kucik, Cynthia H. Cassell and Clinton J. Alverson are with the Division of Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta. Pamela Donohue is with the Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD. Jean Paul Tanner and Russell S. Kirby are with the Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa. Cynthia S. Minkovitz is with the Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Jane Correia is with the Florida Birth Defects Registry, Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee. Thomas Burke is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health.
authors.forename: James E
authors.initials: JE
authors.lastname: Kucik
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Cassell
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Alverson
authors.forename: Pamela
authors.initials: P
authors.lastname: Donohue
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Tanner
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Minkovitz
authors.forename: Jane
authors.initials: J
authors.lastname: Correia
authors.forename: Thomas
authors.initials: T
authors.lastname: Burke
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kirby
mesh_terms: D001724:Birth Weight; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005431:Florida; D006330:Heart Defects, Congenital / Q000208:ethnology / Q000401:mortality*; D006801:Humans; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D011295:Prenatal Care / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D012959:Socioeconomic Factors