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Regional variation in gastroschisis: a nationwide database review of demographics and outcomes
Sathyaprasad Burjonrappa1,2, Alana N Snyder3
1University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA. sathyabc@yahoo.com.
Insights
Gastroschisis incidence is rising, with regional variations in patient demographics, costs, and length of stay, though mortality remains similar. Understanding these differences can help develop best practices for neonatal care.
Area of Science:
- Neonatal Malformations
- Public Health
- Healthcare Disparities
Background:
- Gastroschisis, a significant birth defect, shows a concerning increase in incidence.
- Investigating regional disparities in gastroschisis is crucial due to rising rates.
Purpose of the Study:
- To analyze geographic variations in gastroschisis patient demographics.
- To compare outcomes and treatment costs across different U.S. regions.
Main Methods:
- Utilized the 2016 Kids' Inpatient Database (KID) for gastroschisis data.
- Analyzed data across four U.S. geographical regions: Northeast, Midwest, South, and West.
- Employed statistical analyses including Chi-squared tests and logistic regressions.
Main Results:
- Identified a gastroschisis incidence of 5.1 per 10,000 live births in 2016.
- Observed significant regional differences in demographics, length of stay, and treatment costs.
- Found no significant regional variations in gastroschisis mortality rates.
Conclusions:
- Gastroschisis incidence has risen over three decades, linked to socioeconomic factors and demographic shifts.
- Regional variations in gastroschisis necessitate further study for developing equitable best practice guidelines.
- Addressing socioeconomic inequalities is key to mitigating the rise in gastroschisis.
Background:
Gastroschisis is an index neonatal malformation with an increasing incidence from earlier decades. The aim of this study was to investigate regional variations in patient demographics, outcomes, and costs in gastroschisis.
Materials And Methods:
The 2016 kid's inpatient database (KID) obtained from the Healthcare Cost and Utilization Project (HCUP) was used to obtain gastroschisis birth, demographic, and outcome data across four U.S. geographical regions: Northeast, Midwest, South, and West. Categorical variables were analyzed with Pearson's Chi-squared test. Odds ratios (OR) with 95% confidence intervals (CI) were reported for variables with significance (p < 0.05). Appropriate logistic regressions were used for comparing categorical, cardinal, and continuous data.
Results:
2043 gastroschisis cases were obtained from the 2016 KID database with a weighted incidence of 5.1 per 10,000 live births. Incidence of gastroschisis across regions was similar when controlling for a number of hospitals reporting to KID. Prematurity was common, with 59% (1204) of neonates with gastroschisis born at less than 37 weeks. 52% (N = 1067) of gastroschisis infants were male. 46% (955) were White, 9% (178) African American, 22% (450) Hispanic, and 8% (155) other. The overall mortality of gastroschisis in this database was 3.6% (75). The average length of stay was 39 days and average cost of treatment was $357,436. Though without significant differences in mortality, there were significant differences in demographics, costs, and lengths of stay between regions.
Conclusions:
There has been a significant increase in gastroschisis incidence over the last three decades. This significant increase appears to be related to an increase in socioeconomic inequality and an alteration in the population demographics in the United States. Further study of regional variations will facilitate the development of best practice guidelines that benefit all.
