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The epidemiology of infantile hypertrophic pyloric stenosis in New York State, 1983 to 1990
1New York State Department of Health, USA.
Insights
The incidence of infantile hypertrophic pyloric stenosis (IHPS) appears to be declining, partly due to underreporting. Children with IHPS show a higher rate of major malformations compared to the general population.
Area of Science:
- Pediatric Surgery
- Epidemiology
- Public Health
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) is a congenital condition affecting the stomach's outlet.
- Observed trends suggested a potential decline in IHPS incidence.
- Understanding IHPS characteristics and associated conditions is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the apparent decline in infantile hypertrophic pyloric stenosis (IHPS) rates.
- To analyze demographic characteristics of infants diagnosed with IHPS.
- To identify major malformations associated with IHPS.
Main Methods:
- A cohort study comparing IHPS cases with the general live birth population.
- Analysis of IHPS trends using a population-based birth defects registry and hospital discharge data (1983-1990).
- Evaluation of demographic factors and co-occurring malformations in IHPS patients.
Main Results:
- IHPS incidence decreased from 2.4 to 1.7 per 1000 live births between 1984 and 1990.
- Higher IHPS occurrence was linked to white race and male gender; lower occurrence associated with high birth order, older maternal age, higher education, and low birth weight.
- Seven percent of IHPS children had major malformations, compared to 3.7% in the general population, with increased frequency of intestinal malrotation, urinary tract obstructive defects, and esophageal atresia.
Conclusions:
- Underreporting to birth defects registries contributes to the observed decline in IHPS rates.
- Children with IHPS exhibit a higher prevalence of major malformations, potentially influenced by detection bias.
- Further research into environmental and socioeconomic factors associated with IHPS is warranted.
Objectives:
To investigate an apparent decline in the rate of infantile hypertrophic pyloric stenosis (IHPS) and to examine the characteristics of children with IHPS and any associated malformations.
Design:
Cohort study in which children with IHPS were compared with the population of live births. Trends of IHPS were compared in two data sets: a population-based birth defects registry and hospital discharge data.
Participants:
Children with IHPS identified from a birth defects registry and the population of live-born infants born to residents of New York State from 1983 to 1990.
Main Outcome Measure:
Trends in the incidence of IHPS in the two data sets, and demographic characteristics and malformations associated with IHPS.
Results:
The rate of IHPS declined from 2.4 per 1000 live births in 1984 to 1.7 in 1990. White race and male gender were associated with a higher occurrence of IHPS; high birth order, older maternal age, higher maternal education, and low birth weight were associated with lower occurrence. Seven percent of children with IHPS had a major malformation compared with 3.7% of the general population. Three major malformations occurred more frequently in children with IHPS: intestinal malrotation, obstructive defects of the urinary tract, and esophageal atresia. Fewer cases were found in the birth defects registry than in the hospital discharge data.
Conclusions:
Underreporting of IHPS to the birth defects registry accounts for some of the decline. Children with IHPS have more major malformations than the general population, although some of the excess could be attributed to increased detection. Further investigation is needed into the environmental factors, especially socioeconomic, associated with IHPS.