Association between survival of infants with congenital heart defects and medical insurance type

Congenital heart defects (CHDs) are the leading cause of mortality in infants with birth defects and often require access to timely specialized care. This study examined the association between survival of infants with CHDs and medical insurance type. Live-born infants with a CHD born 1998-2007 to Florida resident mothers were identified by the Florida Birth Defects Registry and linked to hospital discharge data. Survival probabilities were examined and log-rank tests were used to determine whether survival differed significantly by insurance type, maternal race, and other selected demographic and clinical characteristics. Cox proportional hazards models were used to derive adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Of the 43,532 infants with a CHD, 46% had private insurance, 44% had public insurance, 3% were uninsured, and 6% had a combination of payers. Uninsured infants with critical CHDs had up to a nearly 5-fold increased mortality risk compared to privately insured infants. Publically insured infants had a 30% reduced mortality risk compared with privately insured infants during the neonatal period, but had a 60% increased risk in the post-neonatal period. Among publically insured infants, non-Hispanic (NH) Blacks had the highest post-neonatal mortality risk (aHR 2.1, 95% CI=1.4-3.0). Adjusting for payer status and other access to care indicators reduced the Black-White disparity in mortality risk by 66%. Payer status had a modest impact on survival that varied by infancy period and maternal race. Identifying barriers to care can allow for more targeted interventions to improve survival for these infants.