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The role of socioeconomic status and the development of congenital heart disease: A scoping review

Deliwe P Ngwezi, Lisa K Hornberger, Alvaro Osornio-Vargas

Introduction: Congenital heart disease (CHD) is the most common congenital anomaly affecting 1% of all live births of which the etiology remains unknown. The incidence is higher in developing countries likely related to low literacy, poverty and higher exposures to hazardous environmental nuisances. The role of socioeconomic status (SES) in CHD development has recently received attention. To gain the breadth of knowledge generated from existing publications, we undertook a scoping review of studies examining the relationship between SES and CHD.

Methods: We searched databases using individual or combination of keywords which included non-Medical Subject Heading (non-MeSH) and MeSH terms. We included original observational studies using cohort, case control or ecologic study designs written in English and from 1980-2017.

Results: We identified 26 studies, most of which were conducted in developed economies with very few from developing economies. The majority (18/26, 69%) examined individual maternal SES variables and the risk of CHD, whilst fewer (4/26, 15%) examined associations with SES at the area level or neighborhood level and others (4/26, 15%) examined the individual, family and neighborhood SES levels to weigh the relative contribution of each SES level in CHD development. Individual maternal low education and low skilled occupation were associated with CHD in half of the studies and another half of the studies found no associations between these variables and CHD. Evidence regarding the influence of neighborhood SES alone or multiple SES variables has been inconclusive as well.

Conclusion: There is a paucity of studies from both developed and even more so from developing countries that have examined the influence of SES in CHD development. More knowledge regarding the contribution of various SES measures (i.e., individual, area level, and combinations) on CHD occurrence is required before relevant and effective interventions can be implemented.