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Survival in infants with Down syndrome, Metropolitan Atlanta, 1979-1998
Sonja A Rasmussen1, Lee-Yang Wong, Adolfo Correa
1National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. skr9@cdc.gov
Insights
Infant survival with Down syndrome (DS) is high, but racial disparities exist. Key factors influencing mortality include maternal race and heart defects, necessitating further research into these survival differences.
Area of Science:
- Pediatric Health
- Genetics and Genomics
- Public Health Surveillance
Background:
- Survival rates and prognostic factors for individuals with Down syndrome (DS) require further elucidation.
- Understanding these factors is crucial for improving care and outcomes for infants with DS.
Purpose of the Study:
- To evaluate the survival probability of infants diagnosed with Down syndrome.
- To identify potential prognostic factors influencing survival in this population.
Main Methods:
- Utilized data from the Metropolitan Atlanta Congenital Defects Program (MACDP) for infants born 1979-1998.
- Employed Kaplan-Meier and Cox proportional hazards models to estimate survival and identify risk factors.
- Vital status was confirmed using hospital records, National Death Index (NDI), and Georgia vital records.
Main Results:
- Estimated 1-year survival probability at 92.9% and 10-year survival at 88.6%.
- Identified maternal race, heart defects, low birth weight, and paternal education as significant prognostic factors in univariate analysis.
- Multivariate analysis confirmed maternal race, heart defects, low birth weight, and their interaction as significantly associated with mortality risk.
Conclusions:
- A notable racial disparity in survival among children with Down syndrome was observed.
- Further research is essential to understand the underlying causes of this racial disparity in survival outcomes.
Objective:
Factors influencing survival among persons with Down syndrome (DS) are not well understood. We sought to evaluate survival of infants with DS and potential prognostic factors.
Study Design:
Infants with DS who were born alive during 1979 to 1998 were identified using the Metropolitan Atlanta Congenital Defects Program (MACDP), a population-based surveillance system. To document vital status, we used data from hospital records, the National Death Index (NDI), and Georgia vital records. We estimated survival probability using the Kaplan-Meier product limit method and hazard ratios using a Cox proportional hazards model.
Results:
Survival probability to 1 year was 92.9% (95% CI: 90.9-94.9) and to 10 years was 88.6% (95% CI: 85.0-92.2). Univariate analysis demonstrated that black maternal race, low birth weight, preterm birth, lower paternal education, presence of heart defects, and presence of other major congenital anomalies were important prognostic factors. After multivariate analysis, maternal race, presence of heart defects, low birth weight, and an interaction between maternal race and presence of heart defects were significantly associated with mortality risk.
Conclusions:
A racial disparity is apparent in survival for children with Down syndrome. Further study is needed to elucidate possible reasons for the racial disparity.
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