Characteristics of Adults With Congenital Heart Defects in the United States

• Authors: Michelle Gurvitz, Boston Childrens Hosp; Julie E Dunn, Massachusetts Department of Public Health; Ami Bhatt, Massachusetts General Hospital; Wendy Book, Emory University; Jill Glidewell, Centers for Disease Control and Prevention Atlanta; Carol Hogue, Emory University; Angela E Lin, MassGeneral Hospital for Children; George Lui, Stanford University; Claire McGarry, New York State Department of Health; Cheryl Raskind-Hood, Emory University; Alissa Van Zutphen, New York State Department of Health; Ali Zaidi, Albert Einstein College of Medicine; Kathy Jenkins, Boston Children’s Hospital; Tiffany Riehle-Colaruso, Centers for Disease Control and Prevention, Atlanta
• Journal Title: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
• Volume: Volume 76, Number 2
• Publisher: ELSEVIER SCIENCE INC | 2020-07-14, Pages 175-182
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jacc.2020.05.025
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; adult congenital heart disease; epidemiology; surveillance; GENERAL-POPULATION; DISEASE PATIENTS; PREVALENCE; HEALTH; CARE; ASSOCIATION; PREDICTORS; MORTALITY; CHILDREN; PATIENT

Abstract

Background: In the United States, >1 million adults are living with congenital heart defects (CHDs), but gaps exist in understanding the health care needs of this growing population. Objectives: This study assessed the demographics, comorbidities, and health care use of adults ages 20 to 64 years with CHDs. Methods: Adults with International Classification of Disease-9th Revision-Clinical Modification CHD-coded health care encounters between January 1, 2008 (January 1, 2009 for Massachusetts) and December 31, 2010 were identified from multiple data sources at 3 U.S. sites: Emory University (EU) in Atlanta, Georgia (5 counties), Massachusetts Department of Public Health (statewide), and New York State Department of Health (11 counties). Demographics, insurance type, comorbidities, and encounter data were collected. CHDs were categorized as severe or not severe, excluding cases with isolated atrial septal defect and/or patent foramen ovale. Results: CHD severity and comorbidities varied across sites, with up to 20% of adults having severe CHD and >50% having ≥1 additional cardiovascular comorbidity. Most adults had ≥1 outpatient encounters (80% EU, 90% Massachusetts, and 53% New York). Insurance type differed across sites, with Massachusetts having a large proportion of Medicaid (75%) and EU and New York having large proportions of private insurance (44% EU, 67% New York). Estimated proportions of adults with CHD-coded health care encounters varied greatly by location, with 1.2 (EU), 10 (Massachusetts), and 0.6 (New York) per 1,000 adults based on 2010 census data. Conclusions: This was the first surveillance effort of adults with CHD-coded inpatient and outpatient health care encounters in 3 U.S. geographic locations using both administrative and clinical data sources. This information will provide a clearer understanding of health care use in this growing population.