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Association of Birth Defects With Child Mortality Before Age 14 Years
Marie-Laure Sattolo1,2, Laura Arbour3, Marianne Bilodeau-Bertrand2
1Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
Insights
Children with birth defects face a significantly higher mortality risk, particularly from circulatory, respiratory, and digestive causes. These findings highlight that the impact of birth defects on child mortality may be underestimated in current statistics.
Area of Science:
- Pediatric Mortality Research
- Congenital Anomalies Epidemiology
- Public Health Surveillance
Background:
- Understanding the causes of death in children with birth defects is crucial for improving pediatric healthcare and outcomes.
- Existing mortality statistics may underestimate the contribution of birth defects to child mortality.
Purpose of the Study:
- To determine and compare mortality rates by cause of death in children with and without birth defects.
- To investigate the association between birth defects and mortality risk in children up to age 14.
Main Methods:
- A population-based longitudinal cohort study in Quebec, Canada, including over 1 million children.
- Follow-up data from birth to age 14 (April 1, 2006, to March 31, 2020), with 7.7 million person-years of observation.
- Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality risk associated with birth defects.
Main Results:
- Children with birth defects had a higher mortality rate (1.3 per 1000 person-years) compared to those without (0.2 per 1000 person-years).
- Birth defects were strongly associated with increased mortality risk from circulatory (HR, 26.59), respiratory (HR, 23.03), and digestive causes (HR, 31.77).
- The greatest risk of death for children with birth defects occurred between 28 and 364 days of life.
Conclusions:
- Birth defects are significantly associated with increased mortality, particularly from circulatory, respiratory, and digestive conditions.
- The study suggests that the role of birth defects in child mortality may be underreported in official statistics.
- These findings underscore the need for comprehensive assessment and management of birth defects to reduce child mortality.
Importance:
Causes of death in children with birth defects are poorly understood.
Objective:
To determine mortality rates by cause of death in children with and without birth defects.
Design, Setting, And Participants:
This longitudinal cohort study included a population-based sample of 1 037 688 children and was conducted in all hospitals in Quebec, Canada, with 7 700 596 person-years of follow-up between birth and age 14 years (April 1, 2006, to March 31, 2020).
Exposures:
Presence or absence of a birth defect.
Main Outcomes And Measures:
Outcomes were all-cause and cause-specific mortality. Hazard ratios (HRs) and 95% CIs were computed for the association between birth defects and mortality with Cox proportional hazards models adjusted for patient characteristics.
Results:
Among the 1 037 688 children in the cohort, 95 566 had birth defects (56.5% boys). There were 532 542 boys in the cohort (51.3%), and mean (SD) age at the end of follow-up was 7.42 (3.72) years. There were 918 deaths among children with defects, and the mean (SD) age was 0.93 (2.07) years at death; there were 1082 deaths among the 942 122 children without defects, and the mean (SD) age at death was 0.50 (1.51) years. Mortality rates were higher for children with birth defects compared with no defect (1.3 vs 0.2 deaths per 1000 person-years, respectively). Girls (HR, 5.66; 95% CI, 4.96-6.47) and boys (HR, 4.69; 95% CI, 4.15-5.29) with birth defects had an elevated risk of death before 14 years compared with unaffected children. Birth defects were associated with mortality from circulatory (HR, 26.59; 95% CI, 17.73-39.87), respiratory (HR, 23.03; 95% CI, 15.09-35.14), and digestive causes (HR, 31.77; 95% CI, 11.87-85.04), but anomalies were rarely listed as the cause of death. Compared with children with no defect, those with birth defects were at greatest risk of death between 28 and 364 days of life.
Conclusions And Relevance:
This cohort study of 1 037 688 children suggests that birth defects were strongly associated with mortality owing to circulatory, respiratory, and digestive causes. This finding suggests that the contribution of birth defects may be underestimated in mortality statistics.
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