Improved treatment of congenital heart defects (CHD) has increased survival; however, little data exist on healthcare utilization, comorbidities, long-term health and non-health outcomes and mortality to inform development of effective secondary prevention strategies. Building on existing infrastructure using individual encounter level data for 2008-2017, we propose to improve understanding of healthcare outcomes over time for patients with CHD; racial/ethnic and socioeconomic patterns in healthcare usage, and their impact on outcomes over time; and age-specific mortality. Through this project, we will gain a greater understanding of the strengths and limitations of integrated CHD surveillance, increase awareness among stakeholders, and improve ability to calculate life expectancies. We propose to: (1) gain a greater understanding of the strengths and limitations of databases used for CHDs surveillance; (2) improve understanding of age-specific mortality, healthcare utilization, comorbidities, survival and other outcomes; (3) improve understanding of racial/ethnic and socioeconomic patterns in healthcare usage, and their impact on long-term outcomes; and (5) increase CHDs awareness among the public and stakeholders. Our source population is the metro-Atlanta 5-county area (3.7 million individuals in 2017, 41 percent black). Regional and community partners enhance our surveillance system, guide education efforts, and ensure data quality and consistency. Through our previous work, we have already demonstrated success in conducting CHD surveillance in the proposed region, and have developed processes to assess data quality and performance measures applicable to the proposed project.