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Incidence of Medical Complexity in Military-Connected Children
JoAnna K Leyenaar1,2, Jackielyn Lanning3,4, Celeste J Romano3,4
1Dartmouth Health Children's, Lebanon, New Hampshire.
Insights
Approximately 1 in 9 US military children develop complex medical conditions by age 5. Congenital anomalies, preterm birth, and low birthweight significantly increase this risk, informing care and resource allocation for these children.
Area of Science:
- Pediatric Health
- Public Health
- Health Services Research
Background:
- Children with medical complexity (CMC) face higher risks of adverse health outcomes and mortality.
- Supporting the specialized needs of CMC requires understanding their diagnosis incidence and risk factors.
- This study focuses on a US military family cohort to identify CMC prevalence and associated birth outcomes.
Purpose of the Study:
- To estimate the cumulative incidence of diagnoses defining CMC by age 60 months in live births among US military families.
- To examine the association between specific birth outcomes and the development of CMC-defining diagnoses.
Main Methods:
- Retrospective cohort study using Department of Defense health care claims data (2005-2020).
- Identification of CMC using the Complex Chronic Condition Classification System and Pediatric Medical Complexity Algorithm from birth to 60 months.
- Fine-Gray regression models were used to calculate adjusted hazard ratios (aHRs) for birth outcome associations.
Main Results:
- The cumulative incidence of CMC-defining diagnoses by age 60 months was 12.0% (108,133 of 975,233 births).
- One-third of CMC diagnoses occurred neonatally, and nearly two-thirds occurred during infancy.
- High risk for CMC was associated with congenital anomalies (aHR=25.2), very preterm birth (aHR=17.6), and very low birthweight (aHR=13.7).
Conclusions:
- Nearly 1 in 9 children in US military families are diagnosed with complex medical conditions by age 5.
- Preterm delivery, congenital anomalies, and low birthweight are strongly associated with increased risk of CMC.
- Findings support clinical counseling and resource allocation for this vulnerable pediatric population.
Background And Objectives:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
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