P2.003: Not Less Mortality, Just Fewer Survivors: The Unseen Burden of Congenital Heart Disease in Ecuador

Background: Congenital heart disease (CHD) is one of the most common congenital anomalies, and many children born with CHD in resource-limited settings lack access to healthcare services for early detection and timely management. Lower socioeconomic status is associated with a significantly higher disease burden, as well as increased mortality risk. We hypothesize that rural regions experience higher CHD mortality compared to urban areas, and that CHD mortality decreases overall toward the end of the studied period.

Methods: We analyzed publicly available data from the National Institute of Statistics and Census on CHD-related mortality in Ecuadorian pediatric patients, stratified by age (infants [0–2 years], children [2– < 12 years], adolescents [12–18 years], and young adults [≤24 years]); and region (urban vs. rural). We included all types of CHDs, regardless of complexity (ICD codes Q20–Q28).

Results: Throughout the study period, we observed 4,441 CHD-related deaths across all four groups, accounting for 6% of all-cause mortality in pediatric populations. Children experienced the highest mortality (n = 1907), followed by infants (n = 1,722), adolescents (n = 423), and young adults (n = 389). In infants, mortality increased from 131 deaths in 2013 to 162 in 2023, reflecting a rise of 23.7%. In children, mortality decreased slightly from 171 deaths in 2013 to 140 in 2023, a reduction of 18.12%. In adolescents, mortality rose from 35 deaths in 2013 to 41 in 2023, an increase of 17.1%. In young adults, mortality decreased from 37 deaths in 2013 to 21 in 2023, a reduction of 43.2% (Figure 1). Most deaths occurred in urban settings, with a similar distribution between male and female patients (Figure 2). The diagnosis of other congenital malformations of the heart (ICD Q24) had the highest mortality across all groups, suggesting higher complexity CHD involving multiple cardiac and vascular structures.

Conclusion: Despite advances in diagnostic and therapeutic approaches over the last decade, resource-limited settings continue to experience rising mortality. The higher mortality reported in urban areas may reflect the transfer of patients from rural regions to higher-level care centers. The lower mortality among adolescents and young adults may stem from the small number of individuals in this group who survive to adulthood. Public policy interventions focused on identifying socially vulnerable individuals and educating healthcare workers to address these risks could improve outcomes and reduce CHD-related mortality.