{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T04:18:48Z","timestamp":1787545128945,"version":"build-2736575974"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["CDC\u2010RFA\u2010DD15\u20101506"],"award-info":[{"award-number":["CDC\u2010RFA\u2010DD15\u20101506"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Population\u2010based data on healthcare utilization in adults with congenital heart disease (CHD) are limited. We examined utilization patterns in a multi\u2010site, population\u2010based U.S. cohort of adults with CHD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort linked health and administrative records from five regions (Colorado, North Carolina, Utah, metropolitan Atlanta, and New York). Adults aged 19\u201364\u2009years with at least one CHD\u2010related ICD\u20109\u2010CM code recorded during 2011\u20132013 were included. We evaluated inpatient, emergency department (ED), outpatient, and cardiology outpatient encounters, as well as cardiac diagnostic\/imaging, therapeutic\/interventional, and vascular procedures. Multivariable mixed\u2010effects logistic regression models compared utilization by CHD severity (severe vs. non\u2010severe), adjusting for sex, race\/ethnicity, insurance, comorbidity, and site, and including age group as an effect modifier.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over 3\u2009years, this cohort of 18,877 adults (20.7% severe CHD), 45.9% had at least one hospitalization, 35.1% had an ED visit, 92.1% had an outpatient encounter, and 43.8% had a cardiology outpatient visit. Cardiac diagnostic\/imaging procedures occurred in 67.8%, cardiac interventions in 20.3%, and vascular procedures in 10.5%. Severe CHD was associated with higher odds of cardiac procedures but lower odds of ED use than non\u2010severe CHD. Age modified these associations, and site\u2010level variation was marked, with cardiology visit rates ranging from 21% to 59%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adults with CHD had high healthcare utilization, including frequent ED use, yet fewer than half saw a cardiology specialist, particularly at older ages. These findings highlight persistent gaps in lifelong care and substantial geographic variation, underscoring the need to improve access to specialized care for adults with CHD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bdr2.70063","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:51:06Z","timestamp":1780638666000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Health Care Utilization in Adults With Congenital Heart Disease: Population\u2010Based Findings"],"prefix":"10.1002","volume":"118","author":[{"given":"Tessa L.","family":"Crume","sequence":"first","affiliation":[{"name":"Colorado School of Public Health University of Colorado Anschutz Medical Center  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber D.","family":"Khanna","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical 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Medicine, and Rollins School of Public Health  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3301-0980","authenticated-orcid":false,"given":"Cheryl","family":"Raskind\u2010Hood","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine, and Rollins School of Public Health  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Whitehead","sequence":"additional","affiliation":[{"name":"University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelangi","family":"Pinto","sequence":"additional","affiliation":[{"name":"University of Washington  Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9171-7848","authenticated-orcid":false,"given":"Marcia 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