Environmental and socioeconomic factors influence the live-born incidence of congenital heart disease: A population-based study in california

Shabnam Peyvandi, Rebecca J. Baer, Christina D. Chambers, Mary E. Norton, Satish Rajagopal, Kelli K. Ryckman, Anita Moon-Grady, Laura L. Jelliffe-Pawlowski, Martina A. Steurer

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The development of congenital heart disease (CHD) is multifactorial with genetic and environmental influences. We sought to determine the relationship between socioeconomic and environmental factors with the incidence of CHD among live-born infants in California and to determine whether maternal comorbidities are in the causal pathway. METHODS AND RESULTS: This was a population-based cohort study in California (2007–2012). The primary outcome was having significant CHD. Predictors included socioeconomic status and environmental exposure to pollutants determined by U.S. Census data. A social deprivation index and environmental exposure index was assigned based on neighborhood socioeconomic variables, categorized into 4 quartiles. Quartile 1 was the best with the least exposure to pollutants and social deprivation, and quartile 4 was the worst. Multivariate logistic regression and mediation analyses were performed. Among 2 419 651 live-born infants, the incidence of CHD was 3.2 per 1000 live births. The incidence of CHD was significantly higher among those in quartile 4 compared with quartile 1 (social deprivation index: 0.35% versus 0.29%; odds ratio [OR], 1.31; 95% CI, 1.21–1.41; environmental exposure index: 0.35% versus 0.29%; OR, 1.23; 95% CI, 1.15–1.31) after adjusting for maternal race/ ethnicity and age and accounting for the relationship between the 2 primary predictors. Maternal comorbidities explained 13% (95% CI, 10%–20%) of the relationship between social deprivation index and environmental exposure index with the incidence of CHD. CONCLUSIONS: Increased social deprivation and exposure to environmental pollutants are associated with the incidence of live-born CHD in California. Maternal comorbidities explain some, but not all, of this relationship. These findings identify targets for social policy initiatives to minimize health disparities.

Original languageEnglish (US)
Article numbere015255
JournalJournal of the American Heart Association
Volume9
Issue number8
DOIs
StatePublished - Apr 21 2020

Keywords

  • congenital cardiac defect
  • environment
  • health disparities
  • socioeconomic position

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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