Clinical characteristics and healthcare utilization of adults with congenital heart disease on Medicaid insurance in the United States.

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.