title: Community socioeconomic disadvantage and the survival of infants with congenital heart defects.
abstract: OBJECTIVE
  We examined the association between survival of infants with severe congenital heart defects (CHDs) and community-level indicators of socioeconomic status.
  
  
  METHODS
  We identified infants born to residents of Arizona, New Jersey, New York, and Texas between 1999 and 2007 with selected CHDs from 4 population-based, statewide birth defect surveillance programs. We linked data to the 2000 US Census to obtain 11 census tract-level socioeconomic indicators. We estimated survival probabilities and hazard ratios adjusted for individual characteristics.
  
  
  RESULTS
  We observed differences in infant survival for 8 community socioeconomic indicators (P < .05). The greatest mortality risk was associated with residing in communities in the most disadvantaged deciles for poverty (adjusted hazard ratio [AHR] = 1.49; 95% confidence interval [CI]  = 1.11, 1.99), education (AHR = 1.51; 95% CI = 1.16, 1.96), and operator or laborer occupations (AHR = 1.54; 95% CI = 1.16, 1.96). Survival decreased with increasing numbers of indicators that were in the most disadvantaged decile. Community-level mortality risk persisted when we adjusted for individual-level characteristics.
  
  
  CONCLUSIONS
  The increased mortality risk among infants with CHDs living in socioeconomically deprived communities might indicate barriers to quality and timely care at which public health interventions might be targeted.
authors.affiliation: James E. Kucik and Owen Devine are with the Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. Wendy N. Nembhard is with the Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa. Pamela Donohue is with the Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD. Ying Wang is with the Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, New York State Department of Health, Albany, NY. Cynthia S. Minkovitz is with the Department of Population, Family and Reproductive Health, and Thomas Burke is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: James E
authors.initials: JE
authors.lastname: Kucik
authors.forename: Wendy N
authors.initials: WN
authors.lastname: Nembhard
authors.forename: Pamela
authors.initials: P
authors.lastname: Donohue
authors.forename: Owen
authors.initials: O
authors.lastname: Devine
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Minkovitz
authors.forename: Thomas
authors.initials: T
authors.lastname: Burke
mesh_terms: D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006330:Heart Defects, Congenital / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D011203:Poverty / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology