262176 Hospital use and mortality among infants with critical congenital heart disease: How important is timely detection?

Tuesday, October 30, 2012

Cora Peterson, PhD , Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, DHHS, Atlanta, GA
Cynthia Cassell, PhD , Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, DHHS, Atlanta, GA
April Dawson, MPH , Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, DHHS, Atlanta, GA
Tiffany Colarusso, MD , Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, DHHS, Atlanta, GA
Scott Grosse, PhD , National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
Jean Paul Tanner, MPH , Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL
Russell Kirby, PhD , Maternal and Child Health, University of South Florida, Tampa, FL
Jane Correia, BS , Florida Birth Defects Registry, Florida Department of Health, Bureau of Environmental Public Health Medicine, Tallahassee, FL
Sharon Watkins, PhD , Analytical Environmental Epidemiology Program, Florida Department of Health, Bureau of Environmental Public Health Medicine, Tallahassee, FL
Richard Olney, MD, MPH , Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, DHHS, Atlanta, GA
Background: In 2011, the U.S. Secretary of Health and Human Services approved addition of critical congenital heart disease (CCHD) to the Recommended Uniform Screening Panel to help improve timely postnatal CCHD diagnosis and treatment. This research compared mortality and hospital use among infants with timely versus late detected CCHD. Methods: This was a retrospective, population-based study of infants with 12 CCHD types born 1998-2007 using the Florida Birth Defects Registry and hospital discharge records. A CCHD was “late detected” if no ICD-9-CM code indicative of any congenital heart disease appeared in the birth hospitalization record. Differences in health service use between infants with timely versus late detected CCHD were examined using chi-square tests. Results: Among 3,652 infants with CCHD, 16% had late detected CCHD. During the neonatal period, infants with timely detected CCHD had a significantly higher number of hospital admissions, longer length of stay, and greater total hospital charges compared to infants with late detected CCHD. Compared to 7% of infants with late detected CCHD, 19% of infants with timely detected CCHD died during infancy, a statistically significant difference. Conclusions: Results suggest neither cost savings nor lower mortality from timely diagnosis, contrary to previous literature indicating lower mortality associated with timely diagnosis of CCHD. Greater health service use and mortality among neonates with timely detected CCHD in this study might be attributable to differences in disease severity, which will be the subject of further analysis.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Provision of health care to the public
Public health or related nursing
Public health or related public policy

Learning Objectives:
Describe and compare health service use among infants with timely versus late detected critical congenital heart disease Compare mortality among infants with timely versus late detected critical congenital heart disease

Keywords: Birth Defects, Health Care Utilization

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Cynthia H. Cassell, PhD, is an epidemiologist in the Birth Defects Branch at the Centers for Disease Control and Prevention (CDC). She has worked in the field of birth defects for almost a decade, including working at a state health department with a birth defects registry for 5 years. She is the principal investigator of several studies using birth defects registry data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4365.0: Infant and Child Health Poster Session