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Association Between Infant Mortality Attributable to Birth Defects and Payment Source for Delivery - United States,
Insights
Infant mortality from birth defects is higher for babies born via Medicaid-covered deliveries compared to private insurance. This disparity affects both preterm and term infants, particularly those with congenital heart defects and CNS defects.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- Birth defects are a significant cause of infant mortality in the U.S., accounting for about 20% of infant deaths.
- Infant mortality attributable to birth defects (IMBD) rates vary by race, age, and gestational age.
- Insurance type has been linked to survival rates in infants with congenital heart defects (CHD).
Purpose of the Study:
- To assess infant mortality attributable to birth defects (IMBD) based on the principal payment source for delivery.
- To compare IMBD rates between deliveries covered by Medicaid and private insurance.
Main Methods:
- Analysis of linked U.S. birth and infant death data from 2011-2013.
- Inclusion of data from states that adopted the 2003 revision of the U.S. standard birth certificate, which includes principal payment source for delivery.
- Stratification of analysis by gestational age (preterm vs. term) and infant age at death (neonatal vs. postneonatal).
Main Results:
- Infants born via Medicaid-covered deliveries had higher IMBD rates than those covered by private insurance, for both preterm and term infants.
- This difference was observed in both neonatal and postneonatal periods.
- Similar disparities in postneonatal mortality were noted for major birth defect categories: central nervous system (CNS) defects, CHD, and chromosomal abnormalities.
Conclusions:
- Higher infant mortality rates attributable to birth defects are associated with Medicaid-covered deliveries compared to private insurance.
- Strategies aimed at improving quality and access to care may help reduce these disparities.
- Further research into the specific factors contributing to these differences is warranted.
Abstract:
Birth defects are a leading cause of infant mortality in the United States (1), accounting for approximately 20% of infant deaths. The rate of infant mortality attributable to birth defects (IMBD) in the United States in 2014 was 11.9 per 10,000 live births (1). Rates of IMBD differ by race/ethnicity (2), age group at death (2), and gestational age at birth (3). Insurance type is associated with survival among infants with congenital heart defects (CHD) (4). In 2003, a checkbox indicating principal payment source for delivery was added to the U.S. standard birth certificate (5). To assess IMBD by payment source for delivery, CDC analyzed linked U.S. birth/infant death data for 2011-2013 from states that adopted the 2003 revision of the birth certificate. The results indicated that IMBD rates for preterm (<37 weeks of gestation) and term (≥37 weeks) infants whose deliveries were covered by Medicaid were higher during the neonatal (<28 days) and postneonatal (≥28 days to <1 year) periods compared with infants whose deliveries were covered by private insurance. Similar differences in postneonatal mortality were observed for the three most common categories of birth defects listed as a cause of death: central nervous system (CNS) defects, CHD, and chromosomal abnormalities. Strategies to ensure quality of care and access to care might reduce the difference between deliveries covered by Medicaid and those covered by private insurance.
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