{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:54:12Z","timestamp":1792004052860,"version":"4.4.0"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Socioeconomic status (SES) and distance of residence from tertiary care may impact fetal detection of congenital heart disease (CHD), partly through reduced access to and quality of obstetric ultrasound screening. It is unknown whether SES and remoteness of residence (RoR) affect prenatal detection of CHD in jurisdictions with universal health coverage. We examined the impact of SES and RoR on the rate and timing of prenatal diagnosis of major CHD within the province of Alberta in Canada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective study, we identified all fetuses and infants diagnosed with major CHD in Alberta, from 2008 to 2018, that underwent cardiac surgical intervention within the first\u2009year after birth, died preoperatively, were stillborn or underwent termination. Using maternal residence postal code and geocoding, Chan SES index quintile, geographic distance from a tertiary\u2010care fetal cardiology center and the Canadian Index of Remoteness (IoR) were calculated. Outcome measures included rates of prenatal diagnosis and diagnosis after 22\u2009weeks' gestation. Risk ratios (RR) were calculated using log\u2010binomial regression and stratified by rural (\u2265\u2009100\u2009km from tertiary care) or metropolitan (&lt;\u2009100\u2009km from tertiary care) residence, adjusting for year of birth and the obstetric ultrasound  screening view in which CHD would most likely be detected (four\u2010chamber view; outflow\u2010tract view; three\u2010vessel or three\u2010vessels\u2010and\u2010trachea or non\u2010standard view; septal view).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1405 fetuses\/infants with major CHD, prenatal diagnosis occurred in 814 (57.9%). Residence \u2265\u2009100\u2009km from tertiary care (adjusted RR, 1.19; 95%\u2009CI, 1.05\u20131.34) and higher IoR (adjusted RR, 1.9; 95%\u2009CI, 1.1\u20133.3) were associated with missed prenatal diagnosis of major CHD. Similarly, residence \u2265\u2009100\u2009km from tertiary care (adjusted RR, 1.41; 95%\u2009CI, 1.22\u20131.62) and higher IoR (adjusted RR, 3.6; 95%\u2009CI, 2.2\u20138.2) were associated with prenatal diagnosis after 22\u2009weeks. Although adjusted and unadjusted analyses showed no association between Chan SES index quintile and prenatal\u2010diagnosis rate overall nor for residence in rural areas, in metropolitan regions, lower SES quintiles were associated with missed prenatal diagnosis (quintile 1: RR, 1.24; 95%\u2009CI, 1.02\u20131.50) and higher risk of diagnosis after 22\u2009weeks' gestation (quintile 1: RR, 1.46; 95%\u2009CI, 1.10\u20131.93; quintile 2: RR, 1.66; 95%\u2009CI, 1.24\u20132.23).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite universal healthcare, rural residence in Alberta is associated with lower rate of prenatal diagnosis of major CHD and higher risk of late prenatal diagnosis (\u2265\u200922\u2009weeks). Within metropolitan regions, lower SES impacts negatively prenatal\u2010diagnosis rate and timing. \u00a9 2022 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26030","type":"journal-article","created":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T16:40:35Z","timestamp":1657903235000},"page":"359-366","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Impact of rural residence and low socioeconomic status on rate and timing of prenatal detection of major congenital heart disease in a jurisdiction of universal health coverage"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2835-3281","authenticated-orcid":false,"given":"A.","family":"Kaur","sequence":"first","affiliation":[{"name":"Fetal &amp; Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women's &amp; Children's Health Research Institute University of Alberta  Edmonton AB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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