title: Indigenous Ethnicity and Low Maternal Education Are Associated with Delayed Diagnosis and Mortality in Infants with Congenital Heart Defects in Panama.
abstract: BACKGROUND
  This is the first study in Panama and Central America that has included indigenous populations in an assessment of the association between socioeconomic variables with delayed diagnosis and mortality due to congenital heart defects (CHD).
  
  
  METHODS
  A retrospective observational study was conducted. A sample calculation was performed and 954 infants born from 2010 to 2014 were randomly selected from clinical records of all Panamanian public health institutions with paediatric cardiologists. Critical CHD was defined according to the defects listed as targets of newborn pulse oximetry screening. Diagnoses were considered delayed when made after the third day of life for the critical CHD and after the twentieth day of life for the non-critical. A logistic regression model was performed to examine the association between socioeconomic variables and delayed diagnosis. A Cox proportional hazards model was used to assess the relationship between socioeconomic features and mortality.
  
  
  RESULTS
  An increased risk of delayed diagnosis was observed in infants with indigenous ethnicity (AOR, 1.56; 95% CI, 1.03-2.37), low maternal education (AOR, 1.57; 95% CI, 1.09-2.25) and homebirth (AOR, 4.32; 95% CI, 1.63-11.48). Indigenous infants had a higher risk of dying due to CHD (HR, 1.43; 95% CI, 1.03-1.99), as did those with low maternal education (HR, 1.95; 95% CI, 1.45-2.62).
  
  
  CONCLUSIONS
  Inequalities in access to health care, conditioned by unfavourable socioeconomic features, may play a key role in delayed diagnosis and mortality of CHD patients. Further studies are required to study the relationship between indigenous ethnicity and these adverse health outcomes.
authors.affiliation: Department of Research and Health Technology Assessment, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama.
authors.forename: Franz
authors.identifier: http://orcid.org/0000-0002-9913-4257
authors.initials: F
authors.lastname: Castro
authors.affiliation: Department of Research and Health Technology Assessment, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama.
authors.forename: Julio
authors.initials: J
authors.lastname: Zúñiga
authors.affiliation: Department of Research and Health Technology Assessment, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama.
authors.forename: Gladys
authors.initials: G
authors.lastname: Higuera
authors.affiliation: Department of Research and Health Technology Assessment, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama.
authors.forename: María
authors.initials: M
authors.lastname: Carrión Donderis
authors.affiliation: Department of Research and Health Technology Assessment, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Gómez
authors.affiliation: Department of Research and Health Technology Assessment, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama.
authors.forename: Jorge
authors.initials: J
authors.lastname: Motta
mesh_terms: D057210:Delayed Diagnosis; D004522:Educational Status; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality; D006801:Humans; D007199:Indians, South American / Q000706:statistics & numerical data*; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D009035:Mothers; D010176:Panama / Q000453:epidemiology; D016016:Proportional Hazards Models; D062486:Public Health Surveillance / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors