CHD infant mortality disparities in the USA: Positive changes in the previously worst performing state

Background

From 2006 to 2015, Kentucky had the highest rate of infant mortality attributable to congenital heart disease (CHD) in the USA. Across the country, mortality was associated with male sex, prematurity, non-Hispanic black race, lower maternal education, higher % of poverty, and increasing distance from a top 50 cardiac center.

Objectives

We sought to update these observations during a more contemporary era, with specific emphasis on Kentucky's performance.

Methods

The National Center for Health Statistics linked birth and infant death period data sets from 2016 to 2020 were used to calculate the incidence of CHD infant mortality. Chi-square tests were conducted to test for differences in deaths according to factors of interest for the entire USA and Kentucky. We also examined the mortality rate in Kentucky, which differed from 2016 to 2017 vs. 2018–2020, which coincided with the creation of a joint program between one of Kentucky's pediatric cardiac centers and a top 50 center in Ohio.

Results

There was a national trend for improvement in CHD infant mortality. The national mortality rate in 2016–2020 was 0.3 deaths per 1000 live births compared to 0.34 in 2006–2015 (p < 0.001). Kentucky was no longer among the worst in the USA. In the USA, male sex, prematurity, non-Hispanic black race, lower level of maternal education, and healthcare payment not by private insurance were associated with a higher incidence of mortality (p < 0.001). For Kentucky, prematurity, non-Hispanic black race, poverty, and healthcare payment other than private insurance increased CHD infant mortality. Mortality rates in Kentucky for 2016–2017 and 2018–2020 were similar.

Conclusion

CHD infant mortality improved in the more contemporary era, and Kentucky was no longer the worst performing state. Male sex, prematurity, non-Hispanic black race, lower level of maternal education, and poverty continue to be associated with a higher incidence of CHD infant mortality.