Effect of acculturation and distance from cardiac center on congenital heart disease mortality

David E Fixler, Wendy N. Nembhard, Ping Xu, Mary K. Ethen, Mark A. Canfield

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


BACKGROUND AND OBJECTIVE: Despite improvements in congenital heart disease (CHD) survival over the past 4 decades, ethnic disparities persist. Several studies have shown higher postoperative CHD adjusted mortality in black and Hispanic children. Others noted that non-English-speaking language at home was associated with appointment noncompliance, which the parents attributed to misunderstanding and living too far from a health center. The purpose of this study was to determine the effect of home distance to a cardiac center, or having a Latin American-born parent, on first-year mortality in infants with severe CHD. METHODS: Infants with severe CHD, having an estimated first-year mortality >25%, born 1996-2003, were identified from the Texas Birth Defects Registry and linked to state and national vital records. We examined the effects of defect type; birth weight; gestational age; extracardiac anomalies; infant gender; maternal race/ethnicity, marital status, and education; residence in a Texas county bordering Mexico; home distance to cardiac center; and parental birth country on firstyear survival. RESULTS: Overall first-year survival was 59.9%, and no race/ethnic differences were noted; however, survival was significantly (P < .05) lower for Hispanic infants with hypoplastic left heart syndrome. Neither home distance to a cardiac center nor parental birth country was related to first-year survival; however, survival was noted to be lower in Texas counties bordering Mexico, counties that have high rates of poverty. CONCLUSIONS: Further studies are needed to determine if these disparities in survival of infants with severe CHD are attributable to delays in referral to a cardiac center.

Original languageEnglish (US)
Pages (from-to)1118-1124
Number of pages7
Issue number6
StatePublished - Jun 2012


  • Congenital heart defects
  • Health care evaluation
  • Infant mortality
  • Race/ethnicity
  • Survival

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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