632 - Preterm infant mortality from congenital heart disease: the impact of race

Poster Number: 632
Publication Number: 632.141

Tonia Branche, Northwestern University Feinberg School of Medicine/Lurie Children's Hospital of Chicago, Chicago, IL, United States; Kristin Rankin, University of Illinois at Chicago School of Public Health, Chicago, IL, United States; James Collins, Lurie Children's, Chicago, IL, United States

Background: The racial disparity in infant mortality rates due to congenital heart disease (< 365 days, IMR-CHD) among term infants is driven predominantly by the post-neonatal (28-365d) survival disadvantage of African-American infants (Collins et al, J Pediatr, 2017). The relation of race to the IMR-CHD of preterm (< 37 weeks) births is incompletely understood.

Objective: To determine the importance of African-American race to the IMR-CHD of preterm births

Design/Methods: Using a cross-sectional population-based design, stratified and multivariable logistic regression analyses were performed on the 2016-2018 National Center for Health Statistics cohort linked live birth-infant death database of preterm African-American (n = 232,093) and non-Latinx White (n = 543,354) infants.  Infant mortality rates, including neonatal (< 28d) and post-neonatal components, due to CHD were calculated.

Results: The IMR-CHD for non-Latinx African-American infants (286 deaths; 12.3/10,000 live-births) approximated that of non-Latinx White infants (586 deaths; 10.8/10,000 live-births); RR = 1.1 (1.0, 1.3). Neonatal mortality rates due to CHD didn’t vary by race (Figure 1). The post-neonatal mortality rate due to CHD for non-Latinx African-American infants exceeded that of non-Latinx White infants (Figure 2). African-American (compared to non-Latinx White) infants had a greater percentage of high-risk characteristics (Table).  The adjusted (controlled for maternal demographic, social and behavioral characteristics) RR of infant, neonatal and post-neonatal mortality due to CHD for non-Latinx African American (compared to non-Latinx White) infants equaled 0.8 (0.7, 1.0), 0.7 (0.6, 0.9), and 1.0 (0.8, 1.3) respectively.

Conclusion(s): The overall IMR-CHD of African-American preterm infants approximates that of non-Latinx White preterm infants. African-American infants actually have a neonatal survival advantage when commonly cited individual-level risk factors are considered.  Most notably, this survival advantage abates in the post-neonatal period.  These intriguing findings highlight the importance of unmeasured neighborhood factors and other potential confounders during the post-neonatal period.