Abstract
Background
Social determinants of health (SDH) can substantially impact health outcomes. A systematic review, however, has never been conducted on associations of SDH with congenital heart disease (CHD) outcomes. The aim, therefore, was to conduct such a systematic review.
Methods
Seven databases were searched through May 2020 to identify articles on SDH associations with CHD. SDH examined included poverty, uninsurance, housing instability, parental educational attainment, immigration status, food insecurity, and transportation barriers. Studies were independently selected and coded by two researchers based on the PICO statement.
Results
The search generated 3992 citations; 88 were included in the final database. SDH were significantly associated with a lower likelihood of fetal CHD diagnosis, higher CHD incidence and prevalence, increased infant mortality, adverse post-surgical outcomes (including hospital readmission and death), decreased healthcare access (including missed appointments, no shows, and loss to follow-up), impaired neurodevelopmental outcomes (including IQ and school performance) and quality of life, and adverse outcomes for adults with CHD (including endocarditis, hospitalization, and death).
Conclusions
SDH are associated with a wide range of adverse outcomes for fetuses, children, and adults with CHD. SDH screening and referral to appropriate services has the potential to improve outcomes for CHD patients across the lifespan.
Impact
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Social determinants of health (SDH) are associated with a wide range of adverse outcomes for fetuses, children, and adults with congenital heart disease (CHD).
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This is the first systematic review (to our knowledge) on associations of SDH with congenital heart disease CHD outcomes.
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SDH screening and referral to appropriate services has the potential to improve outcomes for CHD patients across the lifespan.
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Acknowledgements
We thank Brenda Labbe for her administrative support. No extramural financial assistance was received in support of this study.
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All authors made substantial contributions to the study conception and design, acquisition of data, analysis, interpretation of data, drafting the article, and revising the article critically for important intellectual content. Conceptualization: B.D. and G.F.; methodology: B.D., M.G., and G.F.; data curation: B.D., J.H.L., and M.G.; writing: all authors.
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Davey, B., Sinha, R., Lee, J.H. et al. Social determinants of health and outcomes for children and adults with congenital heart disease: a systematic review. Pediatr Res 89, 275–294 (2021). https://doi.org/10.1038/s41390-020-01196-6
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DOI: https://doi.org/10.1038/s41390-020-01196-6
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