State Income Linked to Lower Death Rates in Adults With Congenital Heart Disease

The peer‑reviewed state‑level analysis finds insurance alone often fails to secure specialist care and signals a need for more adult congenital heart specialists.

Overview

Researchers used Global Burden of Disease and U.S. Census data to analyze nearly 300,000 adults with congenital heart disease across U.S. states from 1990–2021 and compared state mortality and disability with median household income and uninsured rates.
The study found that states with higher median household income had lower death rates for adults with congenital heart disease, with income explaining more variation in mortality than the share of uninsured residents.
Investigators report that having insurance did not guarantee access to the specialized lifelong care these patients need, suggesting factors like insurance benefit design, provider networks, travel distance and out‑of‑pocket costs limit real access.
Experts quoted by the authors recommend expanding the ACHD workforce, improving referral and transition systems from pediatric to adult care, widening insurance networks and using telehealth to reach patients in low‑income or rural areas.
The paper is observational and state‑level, so it shows associations not causation, and the authors call for research that directly measures local specialist supply, insurance coverage details and patient‑level access to care to guide policy.