J Am Heart Assoc. 2026 Mar 25:e045411. doi: 10.1161/JAHA.125.045411. Online ahead of print.
ABSTRACT
BACKGROUND: Mortality in adults with congenital heart disease (CHD) is strongly driven by disease complexity. Social determinants of health (SDOH) influence adult CHD (ACHD) health outcomes but their impact on mortality is unclear. This study examined the influence of clinical factors and SDOH on all-cause mortality in patients with ACHD.
METHODS: Single-center retrospective cohort study of patients with ACHD in the Mayo ACHD Registry who had a verifiable residential address between January 1, 2004 and December 31, 2023. Clinical and SDOH indicators were extracted, including insurance type, language, rural-urban commuting area code, and a housing-based socioeconomic index, an individual-level measure of socioeconomic status derived from 4 objective housing characteristics and categorized into quartiles (Q1-Q4). Cox proportional-hazards models were fitted to evaluate associations with mortality, incorporating CHD severity, arrhythmias, SDOH indicators, and other comorbidities. County of residence was included as a random effect, and model discrimination was assessed using the concordance statistic.
RESULTS: Among 6134 patients with ACHD, the mean age was 38±16 years; 51% were male; 78.7% were White and 44.9% had rural residence. Independent predictors of mortality included cyanotic CHD (adjusted hazard ratio [aHR], 5.70 [95% CI, 2.90-11.23]), Fontan palliation (aHR, 4.98 [95% CI, 2.56-9.70]), ventricular tachycardia (aHR, 1.71 [95% CI, 1.16-2.52]), older age at first visit (aHR, 1.05 per year [95% CI, 1.04-1.05]), male sex (aHR, 1.19 [95% CI, 1.03-1.39]), public insurance (aHR, 1.60 [95% CI, 1.35-1.90]), rural residence (aHR, 1.25 [95%, CI 1.06-1.47]), and non-English language (aHR 1.75 [95% CI 1.38-2.23]). The housing-based socioeconomic index quartile was not associated with mortality. The final model achieved a concordance statistic of 0.77.
CONCLUSIONS: Mortality in patients with ACHD is strongly influenced by both clinical factors and SDOH, independent of socioeconomic status. Addressing barriers to care such as language, insurance, and geography is essential for improving ACHD survival particularly in those at increased mortality risk.
PMID:41878868 | DOI:10.1161/JAHA.125.045411
