Get access

Socioeconomic status and prevalence of congenital heart defects: Does universal access to health care system eliminate the gap?§

Authors

  • Mohammad M. Agha,

    Corresponding author
    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    2. Centre for Research on Inner City Health, St. Michael's Hospital, University of Toronto, Toronto, Canada
    3. Paediatric Oncology Group of Ontario, University of Toronto, Toronto, Canada
    4. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
    • Institute for Clinical Evaluative Sciences, 2075 Bayview Ave. Toronto, Ontario, Canada M4N 3M5
    Search for more papers by this author
  • Richard H. Glazier,

    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    2. Centre for Research on Inner City Health, St. Michael's Hospital, University of Toronto, Toronto, Canada
    3. Department of Family and Community Medicine, University of Toronto, Toronto, Canada
    4. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
    Search for more papers by this author
  • Rahim Moineddin,

    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    2. Centre for Research on Inner City Health, St. Michael's Hospital, University of Toronto, Toronto, Canada
    3. Department of Family and Community Medicine, University of Toronto, Toronto, Canada
    Search for more papers by this author
  • Aideen M. Moore,

    1. Division of Paediatric Medicine, the Hospital for Sick Children, University of Toronto, Toronto, Canada
    2. Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
    3. Department of Health Policy Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada
    Search for more papers by this author
  • Astrid Guttmann

    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    2. Division of Paediatric Medicine, the Hospital for Sick Children, University of Toronto, Toronto, Canada
    3. Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
    4. Department of Health Policy Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada
    Search for more papers by this author

  • This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).

  • The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources.

  • §

    No endorsement by Institute for Clinical Evaluative Sciences (ICES) or the Ontario Ministry of Health and Long-Term Care (MOHLTC) is intended or should be inferred.

  • Astrid Guttmann receives salary support from the Canadian Institute for Health Research.

Abstract

BACKGROUND: A twofold increase in the prevalence of congenital heart defects (CHDs) has been reported since the early 1970s with higher rates among children from low socioeconomic status (SES). This increase and the observed SES gap are postulated to be reflective of higher ascertainment, especially increased use of ultrasound and echography. The purpose of this study was to examine if trends over time in the prevalence of CHD were the same for high and low SES groups. METHODS: Using the child's health number as a unique identifier and through record linkage, children born in Ontario between 1994 and 2007 were followed for the diagnosis of CHD. Using postal codes and census information, SES quintiles were assigned to each child. We used adjusted rates and used multivariate models to compare trends in the prevalence rate among children born in different SES groups. RESULTS: Children born in low SES areas (23% of all births) had significantly higher rates of CHDs (rate ratio = 1.20; 95% confidence interval [CI] = 1.15–1.24). While prevalence of nonsevere CHDs declined in all SES groups since 2000, severe CHDs, especially atrial septal defects were on the rise during the study period. DISCUSSION: It is assumed that increased ascertainment is responsible for observed increase in the prevalence of CHD, especially minor defects. While the trend and pattern over time changed for severe and nonsevere CHDs, the SES gap remained consistent during the study period. Our results indicate that even free and universal access to a health care system does not eliminate the SES gap observed in the prevalence of CHD. Birth Defects Research (Part A) 2011. © 2011 Wiley Periodicals, Inc.

Get access to the full text of this article

Ancillary