Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), L'Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France (D.M.P.).
Department of Family and Community Medicine, Northern New England CO-OP Practice and Community Based Research Network, Dartmouth Hitchcock, Lebanon, NH (M.E.S.).
Circ Cardiovasc Qual Outcomes. 2024 Sep;17(9):e010657. doi: 10.1161/CIRCOUTCOMES.123.010657. Epub 2024 Aug 26.
Congenital heart defects (CHD) are the most common birth defects and previous estimates report the disease affects 1% of births annually in the United States. To date, CHD prevalence estimates are inconsistent due to varied definitions, data reliant on birth registries, and are geographically limited. These data sources may not be representative of the total prevalence of the CHD population. It is therefore important to derive high-quality, population-based estimates of the prevalence of CHD to help care for this vulnerable population.
We performed a descriptive, retrospective 8-year analysis using all-payer claims data from Colorado from 2012 to 2019. Children with CHD were identified by applying ) and () diagnosis codes from the American Heart Association-American College of Cardiology harmonized cardiac codes. We included children with CHD <18 years of age who resided in Colorado, had a documented zip code, and had at least 1 health care claim. CHD type was categorized as simple, moderate, and severe disease. Association with comorbid conditions and genetic diagnoses were analyzed using χ test. We used direct standardization to calculate adjusted prevalence rates, controlling for age, sex, primary insurance provider, and urban-rural residence.
We identified 1 566 328 children receiving care in Colorado from 2012 to 2019. Of those, 30 512 children had at least 1 CHD diagnosis, comprising 1.95% (95% CI, 1.93-1.97) of the pediatric population. Over half of the children with CHD also had at least 1 complex chronic condition. After direct standardization, the adjusted prevalence rates show a small increase in simple severity diagnoses across the study period (adjusted rate of 11.5 [2012]-14.4 [2019]; <0.001).
The current study is the first population-level analysis of pediatric CHD in the United States. Using administrative claims data, our study found a higher CHD prevalence and comorbidity burden compared with previous estimates.
先天性心脏病 (CHD) 是最常见的出生缺陷，此前的估计报告显示，该病每年在美国影响 1%的新生儿。迄今为止，由于定义不同、依赖于出生登记的数据以及地域限制，CHD 的患病率估计值不一致。这些数据源可能无法代表 CHD 人群的总体患病率。因此，得出高质量的 CHD 人群患病率的基于人群的估计值非常重要，这有助于为这一脆弱人群提供护理。
我们使用 2012 年至 2019 年来自科罗拉多州的所有支付者索赔数据进行了描述性、回顾性 8 年分析。通过应用美国心脏协会-美国心脏病学院协调的心脏代码中的 () 和 () 诊断代码，确定患有 CHD 的儿童。我们纳入了年龄<18 岁、居住在科罗拉多州、有记录的邮政编码且至少有 1 次医疗保健索赔的患有 CHD 的儿童。根据疾病的严重程度将 CHD 类型分为简单、中度和重度。使用 χ 检验分析与合并症和遗传诊断的相关性。我们使用直接标准化法计算调整后的患病率，控制年龄、性别、主要保险提供者和城乡居住情况。
我们确定了 2012 年至 2019 年在科罗拉多州接受治疗的 1566328 名儿童。其中，有 30512 名儿童至少有 1 次 CHD 诊断，占儿科人群的 1.95%（95%CI，1.93-1.97）。超过一半患有 CHD 的儿童还至少患有 1 种复杂的慢性疾病。经过直接标准化后，研究期间简单严重程度诊断的调整后患病率略有增加（调整后的发病率为 11.5[2012]-14.4[2019]；<0.001）。
本研究是美国首次对儿科 CHD 进行的基于人群的分析。使用行政索赔数据，我们的研究发现 CHD 的患病率和合并症负担高于先前的估计。
