Geospatial Distribution of Prenatally and Postnatally Diagnosed Congenital Heart Disease: Implications for Equitable Care from a Fetal Heart Society Research Collaborative Study.

Autor: Klein JH; Division of Cardiology, Children's National Hospital, Washington, DC. Electronic address: jklein@childrensnational.org., Cuneo B; University of Arizona College of Medicine, Tuscon, AZ., Howley L; Children's Minnesota, Minneapolis, MN., Kavanaugh-McHugh A; Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN., Taylor C; Division of Cardiology, Medical University of South Carolina, Charleston, SC., Chaves AH; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD., Srivastava S; Nemours Cardiac Center, Wilmington, DE., Donofrio MT; Division of Cardiology, Children's National Hospital, Washington, DC., Gourishankar A; Division of Pediatric Hospital Medicine, Children's National Hospital, Washington, DC., Krishnan A; Division of Cardiology, Children's National Hospital, Washington, DC.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2024 Oct; Vol. 273, pp. 114120. Date of Electronic Publication: 2024 May 28.
DOI: 10.1016/j.jpeds.2024.114120
Abstrakt: Objective: To characterize patterns in the geospatial distribution of pre- and postnatally diagnosed congenital heart disease (CHD) across 6 surgical centers.
Study Design: A retrospective, multicenter case series from the Fetal Heart Society identified patients at 6 centers from 2012 through 2016 with prenatally (PrND) or postnatally (PoND) diagnosed hypoplastic left heart syndrome (HLHS) or d-transposition of the great arteries (TGA). Geospatial analysis for clustering was done by the average nearest neighbor (ANN) tool or optimized hot spot tool, depending on spatial unit and data type. Both point location and county case rate per 10 000 live births were assessed for geographic clustering or dispersion.
Results: Of the 453 CHD cases, 26% were PoND (n = 117), and 74% were PrND (n = 336). PrND cases, in all but one center, displayed significant geographic clustering by the ANN. Conversely, PoND cases tended toward geographic dispersion. Dispersion of PoND HLHS occurred in 2 centers (ANN = 1.59, P < .001; and 1.47, P = .016), and PoND TGA occurred in 2 centers (ANN = 1.22, P < .05; and ANN = 1.73, P < .001). Hot spot analysis of all CHD cases (TGA and HLHS combined) revealed clustering near areas of high population density and the tertiary surgical center. Hot spot analysis of county-level case rate, accounting for population density, found variable clustering patterns.
Conclusion: Geographic dispersion among postnatally detected CHD highlights the need for a wider reach of prenatal cardiac diagnosis tailored to the specific needs of a community. Geospatial analysis can support centers in improving the equitable delivery of prenatal care.
Competing Interests: Declaration of Competing Interest American Heart Association (Grant #821139 to JK). The authors declare no conflicts of interest.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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