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Racial and ethnic differences in infant survival for hydrocephaly-Texas, 1999-2017
Munir Ahmed1,2, Charles Shumate2, Heidi Bojes3
1Division of Workforce Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
Infant survival for congenital hydrocephaly without spina bifida in Texas was 82% in the first year. Mortality risk varied by maternal race/ethnicity, clinical factors, and birth characteristics, highlighting disparities in infant outcomes.
Area of Science:
- Pediatric Neurology
- Public Health
- Medical Statistics
Background:
- Congenital hydrocephaly, a condition of excessive fluid in the brain at birth, poses significant risks if untreated.
- Limited data exists on infant survival rates for hydrocephaly in Texas.
- This study addresses the knowledge gap by examining survival in infants with hydrocephaly without spina bifida.
Purpose of the Study:
- To estimate the survival rates of infants born with congenital hydrocephaly without spina bifida in Texas.
- To identify factors associated with one-year infant survival in this population.
Main Methods:
- A cohort of 5709 infants with congenital hydrocephaly without spina bifida was identified from the Texas Birth Defects Registry (1999-2017).
- One-year survival was analyzed using Kaplan-Meier estimates and Cox proportional hazard models.
- Maternal and infant characteristics, including race/ethnicity, were assessed for their impact on survival.
Main Results:
- Overall, 82% of infants survived the first year.
- Survival was significantly influenced by maternal race/ethnicity, clinical classification, preterm birth, birth weight, birth year, and maternal education.
- Infants of non-Hispanic Black and Hispanic mothers faced a higher mortality risk compared to non-Hispanic White mothers.
Conclusions:
- Infant survival for congenital hydrocephaly without spina bifida in Texas is influenced by a range of demographic and clinical factors.
- Mortality remains a significant concern for infants with this condition.
- Further research is necessary to uncover additional mortality risk factors and inform targeted interventions.
Background:
Congenital hydrocephaly, an abnormal accumulation of fluid within the ventricular spaces at birth, can cause disability or death if untreated. Limited information is available about survival of infants born with hydrocephaly in Texas. Therefore, the purpose of the study was to calculate survival estimates among infants born with hydrocephaly without spina bifida in Texas.
Methods:
A cohort of live-born infants delivered during 1999-2017 with congenital hydrocephaly without spina bifida was identified from the Texas Birth Defects Registry. Deaths within 1 year of delivery were identified using vital and medical records. One-year infant survival estimates were generated for multiple descriptive characteristics using the Kaplan-Meier method. Crude hazard ratios (HRs) for one-year survival among infants with congenital hydrocephaly by maternal and infant characteristics and adjusted HRs for maternal race and ethnicity were estimated using Cox proportional hazard models.
Results:
Among 5709 infants born with congenital hydrocephaly without spina bifida, 4681 (82%) survived the first year. The following characteristics were associated with infant survival: maternal race and ethnicity, clinical classification (e.g., chromosomal or syndromic), preterm birth, birth weight, birth year, and maternal education. In the multivariable Cox proportional hazards model, differences in survival were observed by maternal race and ethnicity after adjustment for other maternal and infant characteristics. Infants of non-Hispanic Black (HR: 1.28, 95% CI: 1.04-1.58) and Hispanic (HR: 1.31, 95% CI: 1.12-1.54) women had increased risk for mortality, compared with infants of non-Hispanic White women.
Conclusions:
This study showed infant survival among a Texas cohort differed by maternal race and ethnicity, clinical classification, gestational age, birth weight, birth year, and maternal education in infants with congenital hydrocephaly without spina bifida. Findings confirm that mortality continues to be common among infants with hydrocephaly without spina bifida. Additional research is needed to identify other risk factors of mortality risk.
