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Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980-1997
C Feudtner1, D A Christakis, F A Connell
1Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle, 98195-7183, USA. feudtner@u.washington.edu
Insights
Complex chronic conditions (CCCs) increasingly cause pediatric deaths, with most occurring in infancy. The age of death varies by CCC, but has not changed overall. This highlights the need for tailored support services.
Area of Science:
- Pediatric Mortality
- Public Health
- Chronic Disease Epidemiology
Background:
- Pediatric mortality patterns are shifting due to medical advances.
- Understanding causes of death is crucial for healthcare planning for children.
Purpose of the Study:
- To determine if complex chronic conditions (CCCs) cause an increasing proportion of pediatric deaths.
- To identify the typical age of death for CCC-associated fatalities and assess trends.
- To inform healthcare planning for dying children.
Main Methods:
- Population-based retrospective cohort study (1980-1997).
- Data compiled from Washington State censuses and death certificates for children aged 0-18.
- Analysis included death counts, mortality rates, and ages of death for 9 CCC categories.
Main Results:
- Nearly a quarter of pediatric deaths were attributed to CCCs.
- CCCs accounted for an increasing proportion of deaths in both infants and older children over time.
- The median age of death for CCCs was 4 months 9 days, with no overall increase observed between 1980 and 1997.
Conclusions:
- Complex chronic conditions (CCCs) represent a growing cause of pediatric mortality.
- While most CCC-related deaths occur in infancy, the specific age varies by condition.
- Findings underscore the need for specialized support services for children with chronic conditions and their families.
Objectives:
Advances in medical technology and public health are changing the causes and patterns of pediatric mortality. To better inform health care planning for dying children, we sought to determine if an increasing proportion of pediatric deaths were attributable to an underlying complex chronic condition (CCC), what the typical age of CCC-associated deaths was, and whether this age was increasing.
Design:
Population-based retrospective cohort from 1980 to 1997, compiled from Washington State annual censuses and death certificates of children 0 to 18 years old.
Main Outcome Measures:
For each of 9 categories of CCCs, the counts of death, mortality rates, and ages of death.
Results:
Nearly one-quarter of the 21 617 child deaths during this period were attributable to a CCC. Death rates for the sudden infant death syndrome (SIDS), CCCs, and all other causes each declined, but less so for CCCs. Among infants who died because of causes other than injury or SIDS, 31% of the remaining deaths were attributable to a CCC in 1980 and 41% by 1997; for deaths in children 1 year of age and older, CCCs were cited in 53% in 1980, versus 58% in 1997. The median age of death for all CCCs was 4 months 9 days, with substantial differences among CCCs. No overall change in the age of death between 1980 to 1997 was found (nonparametric trend test).
Conclusions:
CCCs account for an increasing proportion of child deaths. The majority of these deaths occur during infancy, but the typical age varies by cause. These findings should help shape the design of support care services offered to children dying with chronic conditions and their families.