Post-treatment status and unmet treatment needs after congenital heart defect screening policy in school-aged children: a multi-ethnic screening of 1.02 million in China

Objective: This large-scale, multi-ethnic screening of over 1.02 million school-aged children in China aimed to evaluate the real-world impact of recent congenital heart disease (CHD) screening policies by determining the community-based prevalence and clinical management status. Using a novel four-category framework (needing treatment, not needing treatment, postoperative, requiring follow-up), the study sought to identify persistent unmet needs and ethnic disparities in care access following policy implementation. Methods: Between 2024-2025, a cross-sectional screening of 1,024,531 school-aged children (3-18 years) was conducted across 12 ethnically diverse counties in Yunnan, Xinjiang and Chongqing, China. All participants underwent cardiac auscultation and confirmatory echocardiography. CHD cases were classified into one of four categories: Needing treatment, not needing treatment, postoperative, and follow-up. Multi-ethnic disparities in prevalence and defect types were analyzed. Results: A total of 3,376 children were diagnosed with CHD, yielding an overall prevalence of 3.30 per 1,000. Critically, the four-category stratification revealed: 48.7% were postoperative cases, 35.5% required no intervention, 14.3% needed treatment unmet, and 1.5% required further follow-up. Notably, substantial ethnic disparities were observed: Uyghurs had the highest postoperative rate (55%), whereas the Tujia minority group had the highest proportion of untreated but treatable cases. Conclusion: The findings revealed the achievement and underscored gaps in early diagnosis and equitable access to CHD care, particularly among ethnic minorities after CHD screening and care policy implementation, advocating for improved sustainability health policies to reduce unmet CHD needs in multi-ethnic populations.