{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T11:18:45Z","timestamp":1784978325187,"version":"3.55.0"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,6,4]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Socioeconomic factors may lead to a disproportionate impact on health care usage and death among individuals with congenital heart defects (CHD) by race, ethnicity, and socioeconomic factors. How neighborhood poverty affects racial and ethnic disparities in health care usage and death among individuals with CHD across the life span is not well described.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Individuals aged 1 to 64\u2009years, with at least 1 CHD\u2010related\n              <jats:italic>International Classification of Diseases, Ninth Revision, Clinical Modification<\/jats:italic>\n              (\n              <jats:italic>ICD\u20109\u2010CM<\/jats:italic>\n              ) code were identified from health care encounters between January 1, 2011, and December 31, 2013, from 4 US sites. Residence was classified into lower\u2010 or higher\u2010poverty neighborhoods on the basis of zip code tabulation area from the 2014 American Community Survey 5\u2010year estimates. Multivariable logistic regression models, adjusting for site, sex, CHD anatomic severity, and insurance\u2010evaluated associations between race and ethnicity, and health care usage and death, stratified by neighborhood poverty. Of 31\u2009542 individuals, 22.2% were non\u2010Hispanic Black and 17.0% Hispanic. In high\u2010poverty neighborhoods, non\u2010Hispanic Black (44.4%) and Hispanic (47.7%) individuals, respectively, were more likely to be hospitalized (adjusted odds ratio [aOR], 1.2 [95% CI, 1.1\u20131.3]; and aOR, 1.3 [95% CI, 1.2\u20131.5]) and have emergency department visits (aOR, 1.3 [95% CI, 1.2\u20131.5] and aOR, 1.8 [95% CI, 1.5\u20132.0]) compared with non\u2010Hispanic White individuals. In high poverty neighborhoods, non\u2010Hispanic Black individuals with CHD had 1.7 times the odds of death compared with non\u2010Hispanic White individuals in high\u2010poverty neighborhoods (95% CI, 1.1\u20132.7). Racial and ethnic disparities in health care usage were similar in low\u2010poverty neighborhoods, but disparities in death were attenuated (aOR for non\u2010Hispanic Black, 1.2 [95% CI=0.9\u20131.7]).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Racial and ethnic disparities in health care usage were found among individuals with CHD in low\u2010 and high\u2010poverty neighborhoods, but mortality disparities were larger in high\u2010poverty neighborhoods. Understanding individual\u2010 and community\u2010level social determinants of health, including access to health care, may help address racial and ethnic inequities in health care usage and death among individuals with CHD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.033937","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T12:22:01Z","timestamp":1716466921000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Racial and Ethnic Disparities in Health Care Usage and Death by Neighborhood Poverty Among Individuals With Congenital Heart Defects, 4 US Surveillance Sites, 2011 to 2013"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3301-0980","authenticated-orcid":false,"given":"Cheryl L.","family":"Raskind\u2010Hood","sequence":"first","affiliation":[{"name":"Rollins School of Public Health Emory University Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2803-8030","authenticated-orcid":false,"given":"Vijaya","family":"Kancherla","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health Emory University Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5882-2361","authenticated-orcid":false,"given":"Lindsey C.","family":"Ivey","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health Emory University Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4833-3483","authenticated-orcid":false,"suffix":"III","given":"Fred H.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1301-5909","authenticated-orcid":false,"given":"Anaclare M.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"New York State Department of Health Albany NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9190-4536","authenticated-orcid":false,"given":"George K.","family":"Lui","sequence":"additional","affiliation":[{"name":"Divisions of Cardiovascular Medicine and Pediatric Cardiology Stanford University School of Medicine Palo Alto CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5322-7116","authenticated-orcid":false,"given":"Lorenzo","family":"Botto","sequence":"additional","affiliation":[{"name":"Division of Medical Genetics, Department of Pediatrics University of Utah Salt Lake City UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9171-7848","authenticated-orcid":false,"given":"Marcia","family":"Feldkamp","sequence":"additional","affiliation":[{"name":"Division of Medical Genetics, Department of Pediatrics University of Utah Salt Lake City UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3254-1712","authenticated-orcid":false,"given":"Jennifer S.","family":"Li","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4056-7576","authenticated-orcid":false,"given":"Alfred","family":"D'Ottavio","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9773-9009","authenticated-orcid":false,"given":"Sherry L.","family":"Farr","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3905-5458","authenticated-orcid":false,"given":"Jill","family":"Glidewell","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3599-0329","authenticated-orcid":false,"given":"Wendy M.","family":"Book","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)01886-7"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.627224"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2014.07.749"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.09.051"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.02.048"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-2071"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-009-9629-5"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2022.03.017"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.019307"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1589"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.04.037"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.046822"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12732"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2020.06.015"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.15511"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.010342"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2011.01.060"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.881904"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-005-7121-4"},{"key":"e_1_3_2_21_2","unstructured":"National Institute on Minority Health and Health Disparities NIMHD Research Framework. 2017. Accessed June 6 2023. https:\/\/nimhd.nih.gov\/researchFramework."},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2018.304883"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.947002"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.103.19.2376"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.829902"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-002-0243-z"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-017-0384-7"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-2432"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2020.10.040"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2021.04.008"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2021.04.007"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12563"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.024911"},{"key":"e_1_3_2_34_2","unstructured":"U.S. Census Bureau . 2014 American Community Survey (ACS) 5\u2010Year Data Profiles Extracted by ZCTA and GA Counties. 2014. https:\/\/data.census.gov\/table?g=040XX00US13&tid=ACSDP5Y2014.DP05."},{"key":"e_1_3_2_35_2","first-page":"442","article-title":"Racial and ethnic disparities in mortality related to congenital heart defects among children and adults in the United States","volume":"18","author":"Nembhard WN","year":"2008","unstructured":"Nembhard WN, Pathak EB, Schocken DD. Racial and ethnic disparities in mortality related to congenital heart defects among children and adults in the United States. Ethn Dis. 2008;18:442\u2013449.","journal-title":"Ethn Dis"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-019-02104-4"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2014.09.054"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12582"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.005817"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-0803.2007.00119.x"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12169"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10198-021-01300-5"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1177\/21501351221111998"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.020605"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.3102\/0091732X20903321"},{"key":"e_1_3_2_46_2","volume-title":"Crossing the Quality Chasm: A New Health System for the 21st Century","author":"Institute of Medicine (US) Committee on Quality of Health Care in America","year":"2001","unstructured":"Institute of Medicine (US) Committee on Quality of Health Care in America . Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001."},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.21.3.91"},{"key":"e_1_3_2_48_2","volume-title":"Subcommittee on Standardized Collection of Race\/Ethnicity Data for Healthcare Quality Improvement. Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement","author":"Institute of Medicine (US)","year":"2009","unstructured":"Institute of Medicine (US) . In: Ulmer C, McFadden B, Nerenz DR, eds Subcommittee on Standardized Collection of Race\/Ethnicity Data for Healthcare Quality Improvement. Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement. National Academies Press (US); 2009."},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.20973"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.123.033937","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T16:36:23Z","timestamp":1717518983000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.123.033937"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,4]]},"references-count":48,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,6,4]]}},"alternative-id":["10.1161\/JAHA.123.033937"],"URL":"https:\/\/doi.org\/10.1161\/jaha.123.033937","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,4]]},"assertion":[{"value":"2023-12-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e033937"}}