Incidence of Medical Complexity in Military-Connected Children

Children with medical complexity (CMC) are at substantially increased risk for adverse health outcomes and mortality, justifying programs and policies to support their specialized needs. To inform such efforts, this study estimated the cumulative incidence of CMC-defining diagnoses by age 60 months in a cohort of live births among US military families and measured associations between birth outcomes and these diagnoses.

This retrospective cohort study analyzed Department of Defense Birth and Infant Health Research program data from 2005 to 2020. Health care claims were used to identify CMC born between 2005 and 2015 and diagnosed from birth until age 60 months using the Complex Chronic Condition Classification System and Pediatric Medical Complexity Algorithm. The cumulative incidence of medical complexity was estimated, and Fine-Gray regression models calculated adjusted hazard ratios (aHRs) and 95% CIs for associations between birth outcomes and CMC-defining diagnoses.

Among 975 233 live births, the estimated cumulative incidence of CMC-defining diagnoses by age 60 months was 12.0% (95% CI, 11.9-12.1, n = 108 133), with one-third diagnosed during the neonatal period and almost two-thirds diagnosed during infancy. Risk was highest for children born with vs without congenital anomalies (aHR = 25.2; 95% CI, 24.4-25.9), very preterm vs nonpreterm (aHR = 17.6; 95% CI, 17.0-18.2), and very low birthweight vs normal/high birthweight (aHR = 13.7; 95% CI, 13.3-14.2).

Approximately 1 in 9 military-connected children were diagnosed with complex medical conditions by age 5, with risk highly associated with preterm delivery, congenital anomalies, and low birthweight. These findings can inform clinical counseling and justify resource allocation to support this population.