International journal of cardiology. Congenital heart disease
June 10, 2026 · via Europe PMC
Clinical characteristics and healthcare utilization of adults with congenital heart disease on Medicaid insurance in the United States.
McGrath LB, Cambron C, Baudier RL, Khan AM.
AI summary — for doctors, generated from the abstract only
In a massive national study of over 260,000 adults with congenital heart disease on Medicaid insurance (a proxy for poverty), researchers found extremely high rates of mental health conditions, substance abuse, disability, and frequent emergency department use, highlighting significant unmet needs in this economically vulnerable population.
What was studied
A descriptive study using a comprehensive national public health insurance database (T-MSIS) covering all 50 US states and territories, identifying 260,535 adults with congenital heart disease on Medicaid insurance (2016-2018), characterizing their demographics, medical and cardiac comorbidities, disability status, substance use, and healthcare utilization patterns, both overall and by disease complexity.
Key findings
- Among 260,535 adults with congenital heart disease on Medicaid (63.1% female, mean age 40.2, 44.5% with moderate or complex disease, 5.8% died during the study period), common comorbidities included heart rhythm disorders (46.7%), mental health diagnoses (44.9%), high blood pressure (44.6%), and metabolic syndrome (42.4%).
- Nearly a quarter (24.8%) had a disability, 15.5% had a diagnosis consistent with substance abuse, and 17.7% used nicotine products.
- Healthcare utilization was substantial, with 23.9% having one or more hospitalizations per year equivalent and 32.1% having 5 or more emergency department visits over three years equivalent.
Clinical relevance
These findings reveal a strikingly vulnerable population of adults with congenital heart disease on Medicaid (a marker of poverty), characterized by high rates of comorbid mental health and substance use issues alongside their heart condition and heavy reliance on emergency care, supporting the need for targeted, integrated interventions addressing these comorbidities to reduce the burden of disease and improve long-term outcomes in this economically disadvantaged group.
Who should care
Limitations
This is a descriptive database study without a comparison group of non-Medicaid congenital heart disease patients, limiting direct conclusions about the specific impact of poverty/Medicaid status versus disease severity alone; the database relies on diagnosis codes, which may not perfectly capture clinical severity or circumstances.
Adults with congenital heart disease who rely on Medicaid insurance, a marker of poverty, showed strikingly high rates of mental health problems, substance abuse, disability, and frequent emergency room visits, highlighting a vulnerable population that could benefit from more comprehensive, integrated care.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Introduction
Poverty is linked to an increased risk of acquired heart disease, but its impact on outcomes in adults with congenital heart disease (CHD) is not well defined. Medicaid insurance is a strong proxy for poverty in United States. We characterize population characteristics and healthcare utilization among adults with CHD on Medicaid insurance, both overall and by CHD disease complexity.
Methods
The Transformed Medicaid Statistical Information System (T-MSIS) collects comprehensive public health insurance data from all 50 states and territories (Medicaid and Children's Health Insurance Program). We identified 260,535 adults (>18 years of age) with ICD-10 diagnosis codes consistent with CHD across the years 2016-2018. Descriptive statistics were used to compare groups.
Results
Of 260,535 adults with CHD studied, 63.1% were female with a mean age of 40.2 ± 19.1 years. 44.5% had moderate or complex CHD, and 5.8% died during the study period. Medical and cardiac comorbidities were common: rhythm disorders (46.7%), mental health diagnoses (44.9%), hypertension (44.6%), and metabolic syndrome (42.4%). One quarter (24.8%) had a disability, 15.5% had a diagnosis consistent with substance abuse, and 17.7% used nicotine. 23.9% had incidence equivalents of one or more hospitalizations per year, and 32.1% had incidence equivalents of ≥5 emergency department visits in three years.
Conclusion
We characterized the population of adults with CHD on Medicaid and found high rates of medical comorbidities, disability, smoking, substance use, and utilization of emergency department services. This vulnerable population may benefit from targeted interventions aimed at reducing comorbid conditions and thus improving long term outcomes.
DOI
10.1016/j.ijcchd.2026.100687
PMID
42376566
PMCID
PMC13311782
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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