{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:33:05Z","timestamp":1787160785805,"version":"build-2736575974"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,8,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The GBD (Global Burden of Disease) study provides a unique opportunity to better understand the socioeconomic and geographical drivers of clinical outcomes and mortality in adult congenital heart disease (ACHD) in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We performed a secondary data analysis using a population\u2010based observational study design that studied state specific data on mortality and disability\u2010adjusted life years from 1990 to 2021 for patients with ACHD aged 20\u2009years and older in the United States. These data were acquired from the GBD study. We subsequently correlated these data with median household income and percentage of uninsured people in each state by using the US census bureau poverty and income data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In 2021, the GBD study identified 292\u2009624 (95% CI, 258\u2009956\u2013342\u2009906) adults \u226520\u2009years with CHD living in the United States with 1074 (95% CI, 964\u20131331) ACHD related deaths and 62\u2009244 (95% CI, 51\u2009820\u201376\u2009301) disability\u2010adjusted life years. The state with the highest mortality and disability\u2010adjusted life years (West Virginia) also has one of the lowest median household incomes ($51\u2009122). States with lower ACHD related mortality have higher median household incomes (\n                      <jats:italic toggle=\"no\">r<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =0.62,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      \u2009&lt;\u20090.001). There is a lower correlation between mortality and the percentage of patients uninsured in each state (\n                      <jats:italic toggle=\"no\">r<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =0.14,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.0068).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">The GBD study provides unique insight into ACHD mortality and disability in the United States. Although mortality and disability rates have decreased from 1990 to 2021, patients with ACHD living in states with lower median household income and higher percentage of uninsured people have higher rates of mortality and disability. Ensuring adequate access to specialized care is warranted for this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.046919","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T09:30:05Z","timestamp":1784107805000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Associations Between Socioeconomic Status and Adult Congenital Heart Disease Mortality in the United States: Insights From the Global Burden of Disease Study"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4537-5388","authenticated-orcid":false,"given":"Vasupradha Suresh","family":"Kumar","sequence":"first","affiliation":[{"name":"Children's National Hospital","place":["Washington, USA"]},{"name":"Brown University\/Hasbro Children's Hospital","place":["Providence, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4299-9348","authenticated-orcid":false,"given":"Nicholas","family":"Kassebaum","sequence":"additional","affiliation":[{"name":"Brown University\/Hasbro Children's Hospital","place":["Providence, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5960-8227","authenticated-orcid":false,"given":"Bryanna","family":"Schwartz","sequence":"additional","affiliation":[{"name":"University of Washington","place":["Seattle, USA"]},{"name":"National Institutes of Health (NIH)","place":["Bethesda, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2629-1905","authenticated-orcid":false,"given":"Jennifer","family":"Klein","sequence":"additional","affiliation":[{"name":"Children's National Hospital","place":["Washington, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy","family":"Nakiwala","sequence":"additional","affiliation":[{"name":"Brown University\/Hasbro Children's Hospital","place":["Providence, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6798-2737","authenticated-orcid":false,"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"Children's National Hospital","place":["Washington, USA"]},{"name":"Ochsner Children's Hospital","place":["New Orleans, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7355-6304","authenticated-orcid":false,"given":"Anitha S.","family":"John","sequence":"additional","affiliation":[{"name":"Children's National Hospital","place":["Washington, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","unstructured":"GBD VizHub Interactive Data. Accessed May 2 2026. https:\/\/vizhub.healthdata.org\/gbdresults?params=gbd\u2010api\u20102021\u2010permalink\/47d3a1a1c1e54e15702fa8b6df3459e6."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcchd.2021.100148"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12780"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.019307"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(19)30402-X"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2025.09.006"},{"key":"e_1_3_2_8_2","unstructured":"ICD codes for GBD cause mapping. Accessed May 2 2026. https:\/\/ghdx.healthdata.org\/record\/ihme\u2010data\/gbd\u20102021\u2010causeicd\u2010code\u2010mappings."},{"key":"e_1_3_2_9_2","unstructured":"CodViz. Accessed May 2 2026. https:\/\/vizhub.healthdata.org\/cod\/."},{"key":"e_1_3_2_10_2","unstructured":"EpiViz. Accessed May 2 2026. https:\/\/vizhub.healthdata.org\/epi\/."},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30388-9"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00367"},{"key":"e_1_3_2_13_2","unstructured":"Institute for Health Metrics and Evaluation . Years of life lost (YLL). Accessed May 2 2026. https:\/\/www.healthdata.org\/research\u2010analysis\/about\u2010gbd."},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1406656"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102873"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102998"},{"key":"e_1_3_2_17_2","unstructured":"US Census Bureau . Small Area Health Insurance Estimates. Accessed May 2 2026. https:\/\/www.census.gov\/data\u2010tools\/demo\/sahie\/#\/."},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.060834"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1878"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.025358"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2017.12.014"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.0155"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000228"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.005817"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-018-1080-x"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12819"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/HCQ.0000000000000133"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12771"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.839464"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht358"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.063189"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.008396"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.03.085"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1201\/b13497"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.046919","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T16:33:15Z","timestamp":1787157195000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.046919"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":33,"journal-issue":{"issue":"16","published-print":{"date-parts":[[2026,8,18]]}},"alternative-id":["10.1161\/JAHA.125.046919"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.046919","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"assertion":[{"value":"2025-10-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e046919"}}