Association between maternal race and the occurrence of cyanotic congenital heart disease in the USA
Authors: Ebeh Dandison Nat , Jahanfar Shayesteh 
Published: August 2021

Abstract
Introduction
Overall mortality due to congenital heart disease in the United States declined between 1999 and 2017. However, disparities still exist in occurrence and mortality rates among specific racial/ethnic groups in the USA.
Objective
This study aims to find the association between maternal race and the occurrence of Cyanotic Congenital Health Disease (CCHD) in the USA.
Methods
We carry out analysis on a secondary dataset (2017 Natality) obtained from the US Centers for Disease Control and Prevention. This was analyzed using descriptive, bivariate, and regression analysis. This cross-sectional study obtained socio-demographic information-maternal race, independent and confounder variables (explanatory variables), and the occurrence of Cyanotic Congenital Health Disease (outcome variable) within the reporting States and U.S. territories.
Result
There was a report of 3,864,754 live birth out of 325,719,178 USA races and origin populations for the 2017 review year. A total number of 2130 CCHD birth was reported to have occurred out of the 3,8161,947 live births. The Chi-square test showed a statistically significant association between maternal race and the occurrence of CCHD. As well as, the following confounders mother's age, mother's nativity, combined gestation, pre-pregnancy diabetes, pre-pregnancy hypertension, month prenatal care began, smoking status, and Nutrition (WIC) all having a p-value of 0.01 each, respectively.
Unadjusted odds ratios at 95 % CI of the association between maternal race and CCHD were 56 % higher among American Indian and Alaska Native women (95% CI 1.13-2.15) than the white racial group. In addition, the Odds were 13% (95% CI 0.78-0.98) and 46% (95% CI 0.43-0.66) less likely amongst Black and Asian or Pacific Islander, respectively. The odds were 402% markedly high for pre-pregnancy diabetes, 159% for pre-pregnancy hypertension, 38 % for smoking status, and 44%, 159%, and 42% respectively for prenatal care from 1st to 2nd months, 4th to 6th months, and 7th to the final month, when compared to no prenatal care. The odds of having a CCHD was 16% less likely for mothers on Nutrition (mothers on WIC) (95% CI 0.77-0.92), 19% (95% CI 0.73-0.90) for mothers age (under 35 years) category, and likewise for mothers born outside of the USA at 39% (95% CI 1.22-1.56).
On Adjustment for confounders, the OR for this relationship was on the higher side for many of the variables. The odds of occurrence of CCHD were 59 % higher among Black (95% CI 1.27-2.0), 35% among AIAN (95 % CI 1.05-1.74), and 92 % among American Indian and Alaska Native (95 % CI 1.26-2.93) racial categories when compared to Asian or Pacific Islander categories. The odds of having a CCHD was also elevated on adjustment for mothers born outside of the USA at 39% (95% CI 1.22-1.56), and at from the 7th to final month 94% (95% CI 1.38-2.73). However, the odds were insignificant in other categories and variables. These estimates suggest the occurrence of a CCHD is associated with the analyzed independent predictor and confounder variables.
Conclusion
An association exists between maternal race and the occurrence of cyanotic congenital heart disease in the USA. Further research in this area, may therefore help to diminish the occurrence, morbidity, and or mortality of CCHD in America and globally as well.
Keywords: Association, maternal race, cyanotic congenital heart disease, USA