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APHA Scientific Session and Event Listing

Judith Weiss, ScD¹, Milton Kotelchuck, MPH, PhD, MA¹, Marlene Anderka, MPH², Diego F. Wyszynski, MD, MHS, PhD³, Scott Grosse, PhD⁴, Raul Garcia, DMD, MMS⁵, Wanda Barfield, MD, MPH⁶, Howard Cabral, PhD⁷, Emily Lu, MPH⁶, Cathleen A. Higgins², Stephen Evans, MPH⁸, and Jessica A. Taubner, MPH candidate⁹. (1) Department of Maternal and Child Health, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, (617) 414-1441, jw21@bu.edu, (2) MA Center for Birth Defects Research and Prevention, MA Department of Public Health, 250 Washington St., 5th floor, Boston, MA 02108, (3) Department of Medicine, Genetics Program, Boston University School of Medicine, 715 Albany St., Boston, MA 02118, (4) National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mail Stop E-87, Atlanta, GA 30333, (5) Health Policy and Health Services Research, Boston University School of Dental Medicine, 560 Harrison St., Rm 322, Boston, MA 02118, (6) Statistics & Evaluation, Massachusetts Dept. of Public Health, 250 Washington Street, Fifth Floor, Boston, MA 02108, (7) School of Public Health, Boston University, 715 Albany Street, Talbot Bldg., Boston, MA 02118, (8) Data Coordinating Center, Boston University School of Public Health, 580 Harrison Ave., Boston, MA 02118, (9) Maternal and Child Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118

PURPOSE: To assess hospital utilization and associated costs in a population-based cohort of children born in Massachusetts with orofacial clefts, which are among the most common birth defects in the U.S.

STUDY DESIGN: Population-based cohort study of children born alive with cleft palates and/or cleft lips (N=511) compared to all other Massachusetts resident children born between 1998 and 2002 (N=398,244). Data were derived from the Pregnancy to Early Life Longitudinal (PELL) Data System using data from the Massachusetts Birth Defects Registry linked to birth certificate, hospital delivery, and all post-birth hospital discharge, observational stay and emergency department data to age 2. Number of hospitalizations, types of diagnoses and procedures, and associated costs will be assessed and compared, controlling for severity and selected sociodemographic characteristics.

PRELIMINARY RESULTS: Among the 511 children born with an orofacial cleft, 225 (44%) had a cleft palate only, 107 (21%) had a cleft lip only, and 179 (35%) had both. Two thirds (68%) had an isolated (n=285) or isolated with minor (n=60) defect, while 32% had an associated syndrome, sequence or multiple major deformities. Number of post-birth hospitalizations ranged from 0 to 20. Less than half had one post-birth hospitalization, 25% had 2 or 3, 7% had 4 or more, and 21% had none (21 died at <6 months).

IMPLICATIONS: The financial burden of birth defects is substantial. The PELL data provide a unique platform to study the course and cost of treatment for common birth defects such as orofacial clefts.

Learning Objectives:

• Describe the use of hospital services and associated costs among children with orofacial clefts in Massachusetts.
• Identify differences in hospital use and cost between children with orofacial clefts and all other children.
• Discuss the benefits of a linked data system to conduct epidemiologic and cost analyses of children with birth defects.

Keywords: Children With Special Needs, Economic Analysis

Presenting author's disclosure statement:

Not Answered