Background

Little is known about geographical variation in infant mortality due to congenital heart disease (CHD) and the social determinants of health that might mediate such variation. We aimed to examine US county-level estimates of infant mortality due to CHD to understand geographical patterns and factors that might influence variation in mortality.

Methods

This US population-based cohort study used linked livebirth–infant death cohort files from the US National Center for Health Statistics from Jan 1, 2006, to Dec 31, 2015. All deaths attributable to congenital heart disease in infants in a given year were included. We used hierarchical Bayesian models to estimate rates of infant mortality due to congenital heart disease for all US counties. We mapped model-based estimates to explore geographical patterns. Covariates included infant sex, gestational age, maternal race and ethnicity, percentage of the county population below the poverty level, and proximity of the county to a US News & World Report 2015 top-50 ranked paediatric cardiac centre.

Findings

From 2006 to 2015, 40 847 089 livebirths occurred, of which there were 13 988 infant deaths attributed to congenital heart disease, with an unadjusted infant mortality rate due to CHD of 0·34 per 1000 livebirths (95% CI 0·34–0·35). Kentucky and Mississippi had the greatest proportions of counties with a predicted rate of infant mortality due to CHD above the 95th percentile. All counties in Connecticut, Massachusetts, and Rhode Island had a predicted rate below the fifth percentile. In the model, lower mortality risk correlated with closer proximity to a top-50 ranked paediatric cardiac centre (odds ratio [OR] 0·890, 95% credible interval [CrI] 0·840–0·942), whereas higher mortality risk correlated with higher levels of poverty (OR 1·181, 95% CrI 1·125–1·239).

Interpretation

Substantial geographical variation exists in infant mortality due to CHD in the USA, highlighting the potential importance of bolstering care delivery for infants from economically deprived communities and areas remote from top-performing paediatric cardiac centres.

Funding

None.

中文翻译：

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婴儿死亡率，由于在美国的先天性心脏疾病的地域差异：以人群为基础的队列研究

背景

对于先天性心脏病 (CHD) 导致的婴儿死亡率的地理差异以及可能调节这种差异的健康的社会决定因素知之甚少。我们的目的是考察婴儿死亡率，因冠心病美国县级估计，了解地理模式和可能的死亡率变化的影响因素。

方法

这个美国人口为基础的队列研究中使用来自美国国家健康统计中心从2006年1月1日联活产，婴儿死亡的队列文件，至12月31日，2015年所有死亡归因于先天性心脏疾病，在某一年的婴儿都包括在内。我们采用分层贝叶斯模型来估计婴儿死亡率因先天性心脏疾病美国所有县。我们映射基于模型的估计，探索地理模式。变量包括婴儿性别，胎龄，产妇种族和民族，在贫困线以下的县人口的百分比，和县的接近到美国新闻与世界报道2015年排名前50位排名小儿心脏中心。

发现

从2006年到2015年，40个847 089活产儿发生，其中有13名988婴儿死亡归因于先天性心脏疾病，未经调整的婴儿死亡率由于0 CHD·每1000个34活产儿（95％CI 0·34-0 ·35）。肯塔基州和密西西比州曾与婴儿死亡率的预测率县的最大比例因冠心病95个百分点以上。在康涅狄格州，马萨诸塞州和罗得岛州所有县有第五个百分位数以下的预测率。在该模型中，低级死亡风险更接近顶部50排相关小儿心脏中心（比值比[OR] 0·890，95％可信区间[值CrI] 0·840-0·942），而较高的死亡率风险具有较高水平的贫穷相关（OR 1·181，95％值CrI 1·125-1·239）。

解释

大量的地理变异婴儿死亡率存在由于美国CHD，突出从顶级表现的小儿心脏中心的远程支持有利于经济从贫困社区的婴幼儿和地区保健服务的潜在重要性。

资金

没有任何。