{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T07:03:46Z","timestamp":1789715026428,"version":"4.0.1"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,4,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Mortality in adults with congenital heart disease (CHD) is strongly driven by disease complexity. Social determinants of health (SDOH) influence adult CHD (ACHD) health outcomes but their impact on mortality is unclear. This study examined the influence of clinical factors and SDOH on all\u2010cause mortality in patients with ACHD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Single\u2010center retrospective cohort study of patients with ACHD in the Mayo ACHD Registry who had a verifiable residential address between January 1, 2004 and December 31, 2023. Clinical and SDOH indicators were extracted, including insurance type, language, rural\u2013urban commuting area code, and a housing\u2010based socioeconomic index, an individual\u2010level measure of socioeconomic status derived from 4 objective housing characteristics and categorized into quartiles (Q1\u2013Q4). Cox proportional\u2010hazards models were fitted to evaluate associations with mortality, incorporating CHD severity, arrhythmias, SDOH indicators, and other comorbidities. County of residence was included as a random effect, and model discrimination was assessed using the concordance statistic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 6134 patients with ACHD, the mean age was 38\u00b116\u2009years; 51% were male; 78.7% were White and 44.9% had rural residence. Independent predictors of mortality included cyanotic CHD (adjusted hazard ratio [aHR], 5.70 [95% CI, 2.90\u201311.23]), Fontan palliation (aHR, 4.98 [95% CI, 2.56\u20139.70]), ventricular tachycardia (aHR, 1.71 [95% CI, 1.16\u20132.52]), older age at first visit (aHR, 1.05 per year [95% CI, 1.04\u20131.05]), male sex (aHR, 1.19 [95% CI, 1.03\u20131.39]), public insurance (aHR, 1.60 [95% CI, 1.35\u20131.90]), rural residence (aHR, 1.25 [95%, CI 1.06\u20131.47]), and non\u2010English language (aHR 1.75 [95% CI 1.38\u20132.23]). The housing\u2010based socioeconomic index quartile was not associated with mortality. The final model achieved a concordance statistic of 0.77.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Mortality in patients with ACHD is strongly influenced by both clinical factors and SDOH, independent of socioeconomic status. Addressing barriers to care such as language, insurance, and geography is essential for improving ACHD survival particularly in those at increased mortality risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.045411","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T09:23:55Z","timestamp":1774430635000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Sociodemographic and Clinical Predictors of Mortality in Adults With Congenital Heart Disease"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9492-8576","authenticated-orcid":false,"given":"Donnchadh","family":"O'Sullivan","sequence":"first","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]},{"name":"Texas Children\u2019s Hospital\/Baylor College of Medicine","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2133-3106","authenticated-orcid":false,"given":"Sahar","family":"Samimi","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital\/Baylor College of Medicine","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5542-1599","authenticated-orcid":false,"given":"Scott","family":"Anjewierden","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8938-2997","authenticated-orcid":false,"given":"Chung\u2010Il","family":"Wi","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2710-6257","authenticated-orcid":false,"given":"Keila N.","family":"Lopez","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital\/Baylor College of Medicine","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8810-3631","authenticated-orcid":false,"given":"Alexander","family":"Egbe","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Watson","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1116-8541","authenticated-orcid":false,"given":"C. Charlie","family":"Jain","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2112-4240","authenticated-orcid":false,"given":"Young J.","family":"Juhn","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8864-8474","authenticated-orcid":false,"given":"William R.","family":"Miranda","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0666-0344","authenticated-orcid":false,"given":"Heidi M.","family":"Connolly","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2831-4568","authenticated-orcid":false,"given":"Malini","family":"Madhavan","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9786-1840","authenticated-orcid":false,"given":"Luke J.","family":"Burchill","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2019.08.014"},{"key":"e_1_3_2_3_2","unstructured":"Anon . 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