Impact of Socioeconomic Status and Rurality on the Rate of Prenatal Detection of Major and Critical Congenital Heart Disease in Western Australia

Abstract

AIM: Prenatal diagnosis of congenital heart disease (CHD) is associated with reduced infant morbidity and mortality. Location and subsequent socioeconomic status influence rates and timing of prenatal diagnoses of CHD. We investigated the impact of socioeconomic status and rurality on the rate of prenatal diagnosis of critical and major CHD in Western Australia (WA). METHODS: This retrospective cross-sectional study reviewed all critical (surgical intervention ≤ 30 days of life) and major (surgical intervention ≤ 1 year of life) CHD in WA between 2017 and 2021. Patients were identified from the WA Fetal Cardiology and Perth Children's Hospital Cardiology Databases. Clinical records were used to identify diagnoses, outcomes, postcode, rurality (via the Modified Monash Model [MMM]) and socioeconomic status (Socio-Economic Indexes for Areas [SEIFA] Index of Relative Socio-economic Disadvantage). Postcode was used to estimate SEIFA index and MMM rurality. RESULTS: There were 478 cases with major CHD; 282 (59%) were prenatally diagnosed, of which 268 cases were critical CHD, with a 77% detection rate. Seventy-four percent of patients were from metropolitan areas. The distribution of SEIFA decile (p = 0.15) and MMM (p = 0.09) were not significantly different between pre- and postnatal groups. The diagnosis rate of univentricular CHD was 94% (n = 102) and 49% (n = 180) for CHD undergoing biventricular repair. CONCLUSION: Critical CHD increases the likelihood of prenatal diagnosis in WA; however, rurality and socioeconomic status were not found to influence diagnosis rates. Further studies are needed to review the availability of obstetric services in rural communities to ensure equitable healthcare.