Risk Stratification of Long-Term Mortality in Infants with Congenital Diaphragmatic Hernia Using the National Health...

Area of Science:

• Pediatrics
• Public Health
• Medical Informatics

Background:

• Congenital diaphragmatic hernia (CDH) is a severe birth defect with high mortality and morbidity.
• Existing prognostic data for CDH primarily focuses on short-term outcomes from hospital studies.
• Population-level, long-term mortality data for CDH is limited, necessitating nationwide assessments.

Purpose of the Study:

• To estimate the national 5-year all-cause mortality rate for infants diagnosed with CDH.
• To develop a population-level risk stratification nomogram for long-term CDH mortality.
• To utilize nationwide health insurance claims data for comprehensive analysis.

Main Methods:

• A retrospective cohort study design was employed.
• Nationwide health insurance claims data from 2002 to 2016 were analyzed.
• Cox proportional hazards models were used to identify mortality predictors and develop a nomogram.

Main Results:

• Infants with CDH residing in rural areas, with middle-to-high socioeconomic status, experiencing neonatal respiratory distress, or having congenital heart disease (CHD) faced increased 5-year mortality.
• The developed claims-based nomogram showed moderate predictive accuracy (AUC 0.76, C-index 0.78) for stratifying long-term mortality risk.
• Sociodemographic factors and comorbidities were identified as key variables in the risk nomogram.

Conclusions:

• This study provides the first nationwide, population-level estimates of 5-year mortality for congenital diaphragmatic hernia.
• A novel nomogram utilizing claims data offers moderate discriminatory power for long-term risk stratification in CDH patients.
• The findings highlight the importance of considering sociodemographic and clinical factors for predicting long-term CDH outcomes.