The development of a congenital heart defect (CHD) is multifactorial, with many cases having an unknown etiology. This study explored whether maternal race and lived environment were associated with an infant being born with a critical CHD. A cross-sectional, case–control design was conducted utilizing secondary data analysis. The CHD group (N = 199) consisted of infants diagnosed with a critical CHD within the first year of life identified from hospital databases. The non-CHD group (N = 548) was a random sample of infants selected from the state’s vital statistics database. The primary outcome was a critical CHD diagnosis. Maternal race, residential rurality, and the Social Vulnerability Index (SVI) were assessed for associations with a critical CHD using bivariate and multilevel regression models. Bivariate findings reported significance among residential rurality (p < 0.001), SVI ranking overall (p = 0.017), and SVI by theme (theme 1 p = 0.004, theme 2 p < 0.001, theme 3 p = 0.007, and theme 4 p = 0.049) when comparing infants with and without a critical CHD diagnosis. Results of multilevel logistic regression analyses further identified living in a rural residential area compared to urban areas (OR = 7.32; p < 0.001) as a predictor for a critical CHD diagnosis. The findings of lived environmental level associations provides information needed for continued investigation as the burden of a critical CHD continues to impact families, suggesting further research efforts are needed to improve health disparities.

先天性心脏病 (CHD) 的发生是多因素的，许多病例的病因尚不清楚。这项研究探讨了母亲的种族和生活环境是否与出生时患有严重先心病的婴儿有关。利用二次数据分析进行横断面病例对照设计。 CHD 组（N  = 199）由医院数据库中确定的出生后第一年内诊断出患有危重 CHD 的婴儿组成。非 CHD 组 ( N  = 548) 是从州生命统计数据库中随机抽取的婴儿样本。主要结局是严重的冠心病诊断。使用双变量和多级回归模型评估母亲种族、居住农村地区和社会脆弱性指数 (SVI) 与严重先心病的关联。双变量研究结果报告了居住农村地区 ( p  < 0.001)、SVI 总体排名 ( p  = 0.017) 和主题 SVI 之间的显着性（主题 1 p  = 0.004、主题 2 p  < 0.001、主题 3 p  = 0.007 和主题 4 p  = 0.049）在比较有和没有严重 CHD 诊断的婴儿时。多级逻辑回归分析的结果进一步确定，与城市地区相比，居住在农村居民区（OR = 7.32；p  < 0.001）是严重 CHD 诊断的预测因子。由于严重先心病的负担继续影响家庭，生活环境水平协会的调查结果提供了继续调查所需的信息，表明需要进一步的研究工作来改善健康差异。