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Survival Disparities Associated with Congenital Diaphragmatic Hernia
Cynthia F Hinton1, Csaba Siffel1,2, Adolfo Correa1,3
1National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
Survival rates for infants with congenital diaphragmatic hernia (CDH) improved for white infants but not black infants. Poverty and multiple defects impacted survival differently based on race.
Area of Science:
- Pediatric Surgery
- Neonatology
- Public Health
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect affecting infant survival.
- Sociodemographic and clinical factors may influence outcomes in infants with CDH.
Purpose of the Study:
- To assess factors associated with survival in infants diagnosed with congenital diaphragmatic hernia (CDH).
- To investigate racial and socioeconomic disparities in CDH survival rates.
Main Methods:
- Analysis of 150 infants with CDH from 1979-2003 using linked vital records.
- Kaplan-Meier survival analysis and adjusted hazard ratios (HRs) were computed.
- Socioeconomic status, race, and presence of multiple defects were examined.
Main Results:
- Overall survival increased from 40% to 62% during the study period.
- White infants showed improved survival post-1988, unlike black infants.
- Poverty and multiple defects were associated with lower survival in black and white infants, respectively, highlighting racial disparities.
Conclusions:
- Survival improvements for congenital diaphragmatic hernia (CDH) have not benefited all racial groups equally.
- Poverty and comorbidities present distinct challenges for different racial groups, necessitating tailored interventions.
- Addressing health disparities in CDH outcomes requires considering the interplay of race, socioeconomic status, and clinical factors.
Background:
We assessed sociodemographic and clinical factors that are associated with survival among infants with congenital diaphragmatic hernia (CDH).
Methods:
Using data from the Metropolitan Atlanta Congenital Defects Program, we ascertained 150 infants born with CDH between 1979 and 2003 and followed via linkage with state vital records and the National Death Index. Kaplan-Meier survival probabilities and adjusted hazard ratios (HRs) were calculated for socioeconomic and clinical characteristics.
Results:
Survival increased from 40 to 62% over the study period. White infants born before 1988 were 2.9 times less likely to survive than those born after 1988. Black infants' survival did not show significant improvement after 1988. White infants' survival was not significantly affected by poverty, whereas black infants born in higher levels of poverty were 2.7 times less likely to survive than black infants born in lower levels of neighborhood poverty. White infants with multiple major birth defects were 2.6 times less likely to survive than those with CDH alone. The presence of multiple defects was not significantly associated with survival among black infants.
Conclusions:
Survival among infants and children with CDH has improved over time among whites, but not among blacks. Poverty is associated with lower survival among blacks, but not among whites. The presence of multiple defects is associated with lower survival among whites, but not among blacks. The differential effects of poverty and race should be taken into account when studying disparities in health outcomes. Birth Defects Research 109:816-823, 2017. © 2017 Wiley Periodicals, Inc.
