Top Things to Know: Addressing Social Determinants of Health and Mitigating Health Disparities Across the Lifespan in Congenital Heart Disease

Published: April 07, 2022

  1. Improving overall health equity in populations with congenital heart disease (CHD) throughout the lifespan requires recognition of the impact of the social determinants of health (SDOH), systemic inequities, and structural racism on patient outcomes.
  2. This paper summarizes population, systemic, institutional, and individual level factors that contribute to health disparities and proposes strategies for a reduction in these disparities.
  3. Poor access to care remains an issue throughout the lifespan in CHD patients, most often impacting patients in rural areas, patients with governmental insurance, underrepresented minorities (URM), and adults with CHD (ACHD), and results in the highest gaps in cardiac care when transferring between pediatric and adult congenital specialty care.
  4. Conducting studies that assess the impact of the intersectionality between quality of congenital heart surgery, SDOH and mediating factors is critically important as a first step towards improving outcomes for patients with CHD throughout the lifespan.
  5. From 2006 – 2016, the percent of URM physicians in pediatric cardiology fellowships grew slightly, from 7.7% to 9.9%, whereas underrepresented minority pediatric cardiologists still account for only < 8% of the field.
  6. In clinical care and research, race should be understood to be a social construct- differences observed in research between “races” likely results from longstanding structural racism resulting in differences in the SDOH.
  7. Conducting studies that identify and target interventions to reduce variation in care that may result from health care professional, structural, and system level biases and racist practices are critical to reducing health disparities in CHD. This includes assessments of and education for reducing implicit bias and microaggressions.
  8. Diversity of leadership in editors and reviewers for academic cardiac journals, in clinics and hospitals, in URM health care professional recruitment and retention, and on grant review panels, will drive health care delivery systems and research based on equitable, inclusive, and anti-racist policies.
  9. The future of health disparities research in the CHD population includes both qualitative research methods to identify implicit and explicit bias, as well as Community Based Participatory Research (CBPR) to begin interventions that can minimize health disparities with community engagement.
  10. In the care of patients with CHD, holistic, ethically oriented care could address healthcare inequities and SDOH by identifying, investigating, and proposing concrete solutions to improve outcomes and create equitable policies.


Lopez KN, Baker-Smith C, Flores G, Gurvitz M, Karamlou T, Nunez Gallegos F, Pasquali S, Patel A, Peterson JK, Salemi JL, Yancy C, Peyvandi S; on behalf of the American Heart Association Congenital Cardiac Defects Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Epidemiology and Prevention; and Council on Lifestyle and Cardiometabolic Health. Understanding and addressing the impact of social determinants of health and resultant health disparities across the lifespan in congenital heart disease: a scientific statement the American Heart Association. J Am Heart Assoc. 2022;11:e025358. doi: 10.1161/JAHA.122.025358