Ethnicity and socioeconomic status: impact on the diagnosis of congenital heart disease.
OBJECTIVES: The purpose of this study was to estimate the prevalence rates of specific cardiac defects for three ethnic groups and to determine the effects of ethnicity, family income and household education level on the timing of referral for pediatric cardiac care. BACKGROUND: Previous studies examining ethnic differences in rates of congenital heart disease were based on hospital referrals or were limited to diagnoses made in the 1st year of life. These limitations may lead to potential biases in the ascertainment of cases. The present study is population based and includes patients diagnosed after the 1st year of life. METHODS: Cases of congenital heart disease were enumerated among 379,561 liveborn infants to black, white and Mexican-American residents in Dallas County, Texas. Diagnosis was made on the basis of examination by a pediatric cardiologist, two-dimensional echocardiographic studies, cardiac catheterization or observations at operation or at autopsy. Ethnicity, median family income and household educational level were determined from birth certificate information. RESULTS: White children had higher prevalence rates for aortic stenosis, endocardial cushion defect and ventricular septal defect. Mexican-American children had the lowest rate for hypoplastic left heart syndrome. The median age at referral to a pediatric cardiologist was 1.9 months for blacks, 2.1 months for whites and 2.2 months for Mexican-Americans. Stratifying the cases by median family income and household educational level failed to show any significant relation to age at referral. CONCLUSIONS: Prevalence rates of specific cardiac defects vary among black, white and Mexican-American children, probably reflecting different genetic and environmental backgrounds. The timing of referral for pediatric cardiac care, however, was not related to ethnicity, median family income or household educational level.