{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:02:59Z","timestamp":1787313779879,"version":"build-2736575974"},"reference-count":42,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000912","name":"March of Dimes Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U38O2000199"],"award-info":[{"award-number":["U38O2000199"]}],"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":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We assessed healthcare access and utilization among adults with congenital heart defects (ACHD) across racial and ethnic groups using a US population\u2010based sample.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The cross\u2010sectional CH STRONG was conducted from 2016 to 2019 among ACHD in Arkansas, Arizona, and Atlanta. Participants completed a self\u2010administered questionnaire on their healthcare access, utilization, health status, comorbidities, and demographics. Differences in healthcare access and utilization among non\u2010Hispanic White (NH\u2010White), non\u2010Hispanic Black (NH\u2010Black), and Hispanic ACHD were assessed, and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CI) reported. Health\u2010related quality of life (HRQOL) was also compared with standardized norms for the general population from the Patient\u2010Reported Outcomes Measurement Information System (PROMIS). Models were adjusted for age, sex, educational attainment, marital status, study site, and CHD severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1455 respondents, 76.7% were NH\u2010White, 15.0% were NH\u2010Black, and 8.9% were Hispanic. Compared to NH\u2010White, NH\u2010Black ACHD were less likely to have health insurance (aPR\u2009=\u20090.94; CI: 0.88\u20130.99) and more likely to report a prior gap in insurance coverage (aPR\u2009=\u20091.88; CI: 1.44\u20132.46). They were also less likely to have a usual place of care (aPR\u2009=\u20090.82; CI: 0.75\u20130.89) or any healthcare visits (aPR\u2009=\u20090.88; CI: 0.81\u20130.96) but more likely to have \u2265\u20091 emergency room visit (aPR\u2009=\u20091.66; CI: 1.38\u20132.00) and hospitalization (aPR\u2009=\u20091.96; CI: 1.40\u20132.74) in the past year. Hispanic ACHD were more likely than NH\u2010White to report a prior gap in insurance coverage (aPR\u2009=\u20091.78; CI: 1.19\u20132.65). CH STRONG ACHD did not differ from the general population on global mental\u2010health and physical\u2010health scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Racial and ethnic differences in healthcare access and utilization exist among a population\u2010based group of ACHD. Strategies for improvement in access to quality care may help reduce differences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bdr2.70089","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T07:06:18Z","timestamp":1784790378000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Racial and Ethnic Differences in Healthcare Access and Utilization Among Adults With Congenital Heart Defects in the Congenital Heart Survey to Recognize Outcomes, Needs and Well\u2010Being (\n                    <scp>CH STRONG<\/scp>\n                    )"],"prefix":"10.1002","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3199-5261","authenticated-orcid":false,"given":"Mir M.","family":"Ali","sequence":"first","affiliation":[{"name":"Institute for Digital Health and Innovation, College of Medicine, University of Arkansas for Medical Sciences  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4875-7390","authenticated-orcid":false,"given":"Jenil","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Human Genetics and Environmental Sciences The University of Texas Health Science Center at Houston (UTHealth) School of Public Health  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2668-4901","authenticated-orcid":false,"given":"Ruiqi","family":"Cen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fay W Boozman College of Public Health and the Arkansas Center for Birth Defects Research and Prevention University of Arkansas for Medical Sciences  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elijah H.","family":"Bolin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Arkansas for Medical Sciences and Arkansas Children's Hospital  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Goudie","sequence":"additional","affiliation":[{"name":"Arkansas Children's Research Institute  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott E.","family":"Klewer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology) University of Arizona  Tucson Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew E.","family":"Oster","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta and Emory University School of Medicine  Atlanta Georgia USA"},{"name":"National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Glidewell","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3063-1781","authenticated-orcid":false,"given":"Karrie F.","family":"Downing","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherry L.","family":"Farr","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention  Atlanta Georgia 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