Assessing the Impact of Social Factors on Survival Among Infants Born with Transposition of the Great Arteries, Tetralogy of Fallot, and Diaphragmatic Hernia in Texas, 2011-2019.

Introduction: Social factors impact survival for infants with birth defects. This analysis describes the impact of social factors on one-year survival for infants with congenital diaphragmatic hernia (CDH), transposition of the great arteries (TGA), and tetralogy of Fallot (TOF).

Methods: Survival estimates were generated using the Kaplan-Meier method and the log-rank test with 0.05 significance stratified by social factors for infants born 2011-2019 with CDH (N = 942), TGA (N = 1,102), or TOF (N = 1,545). Crude hazard ratios (HR) and adjusted hazard ratios (AHR) with 95% confidence intervals (CI) were calculated for infant death using the Cox proportional hazards models.

Results: One-year survival was 88.7% for TOF, 88.0% for TGA, and 72.7% for CDH. Infants with CDH whose mother resided along the Texas-Mexico border had an increased risk of death compared to non-border residents (HR = 1.68, p =.003). Lower maternal education attainment was associated with increased risk of death for infants with TGA (HR = 1.75, p =.002) or TOF (HR = 1.54, p =.005) compared to infants whose mother had more than a high school education. Maternal Hispanic ethnicity increased the risk of death for infants with TGA (HR = 1.75, p =.005) or TOF (HR = 1.74, p =.002) compared to NH White infants.

Discussion: Hispanic maternal ethnicity, lower maternal educational attainment, and residence along the Texas-Mexico border negatively impact infant one-year survival.