调查 TRICARE 受益人出生队列中脐带绕颈症发病率的短暂上升

IF 1.6 4区 医学 Q4 DEVELOPMENTAL BIOLOGY Birth Defects Research Pub Date : 2024-01-31 DOI:10.1002/bdr2.2305
Jackielyn Lanning, Sandra Michelle Magallon, Anna T. Bukowinski, Gia R. Gumbs, Ava Marie S. Conlin, Clinton Hall
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引用次数: 0

摘要

背景 美国国防部出生和婴儿健康研究(BIHR)计划利用医疗会诊数据对军人家庭出生的婴儿进行出生缺陷监测。脐膨出是一种主要的腹壁缺陷,在 BIHR 数据中的年患病率约为每万名新生儿中 2 例,但在 2017-2019 年期间出现了意外增长,2018 年达到每万名新生儿中 6.4 例。为了调查这种患病率的短暂增长,本研究旨在验证 2016-2021 年出生婴儿中的脐膨出病例算法。 方法 根据一名住院患者或两名门诊患者的婴儿就诊记录中的 ICD-10 代码 Q79.2(颅外畸形)确定脐膨出病例,并使用父母和婴儿的电子健康记录进行验证。使用双变量分析评估了真阳性病例和假阳性病例的特征,并对不同时期的特征进行了比较。 结果 在2016年至2021年的638905例活产中,有230例符合ICD-10对卵脐病例的定义;138例(60.0%)符合验证条件,其中68例(49.3%)为真阳性。真阳性病例从出生到首次确诊 ICD-10 脑积水的几何平均时间为 1.1 天(标准误差 [SE] 0.1),假阳性病例为 11.9 天(标准误差 3.1)。在 70 例假阳性病例中,36 例(51.4%)为确诊脐疝;2017-2019 年期间,假阳性病例中脐疝和延迟脐疝诊断(>出生后 30 天)的比率升高。 结论 2017-2019年期间ICD-10代码Q79.2的误用率较高,可能影响了相关的脐疝患病率的增加。在使用医疗会诊数据进行脐膨出病例定义时应考虑诊断时机。
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Investigation of a transient increase in omphalocele prevalence in a birth cohort of TRICARE beneficiaries

Background

The Department of Defense Birth and Infant Health Research (BIHR) program leverages medical encounter data to conduct birth defect surveillance among infants born to military families. Omphalocele is a major abdominal wall defect with an annual prevalence of ~2 per 10,000 births in BIHR data, but an unexpected increase was observed during 2017–2019, reaching 6.4 per 10,000 births in 2018. To investigate this transient increase in prevalence, this study aimed to validate the omphalocele case algorithm among infants born 2016–2021.

Methods

Omphalocele cases were identified by ICD-10 code Q79.2 (exomphalos) on one inpatient or two outpatient infant encounter records and validated using parental and infant electronic health records. Characteristics of true and false positive cases were assessed using bivariate analyses and compared over time.

Results

Of 638,905 live births from 2016 to 2021, 230 met the ICD-10 case definition for omphalocele; 138 (60.0%) cases were eligible for validation, of which 68 (49.3%) were true positives. The geometric mean time from birth to first ICD-10 omphalocele diagnosis was 1.1 (standard error [SE] 0.1) days for true positives and 11.9 (SE 3.1) days for false positives. Among the 70 false positives, 36 (51.4%) were cases of confirmed umbilical hernia; rates of umbilical hernia and delayed omphalocele diagnoses (>30 days after birth) were elevated among false positives during 2017–2019.

Conclusions

Higher misuse of ICD-10 code Q79.2 during 2017–2019 likely influenced the associated increase in omphalocele prevalence. Timing of diagnosis should be considered for omphalocele case definitions using medical encounter data.

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来源期刊
Birth Defects Research
Birth Defects Research Medicine-Embryology
CiteScore
3.60
自引率
9.50%
发文量
153
期刊介绍: The journal Birth Defects Research publishes original research and reviews in areas related to the etiology of adverse developmental and reproductive outcome. In particular the journal is devoted to the publication of original scientific research that contributes to the understanding of the biology of embryonic development and the prenatal causative factors and mechanisms leading to adverse pregnancy outcomes, namely structural and functional birth defects, pregnancy loss, postnatal functional defects in the human population, and to the identification of prenatal factors and biological mechanisms that reduce these risks. Adverse reproductive and developmental outcomes may have genetic, environmental, nutritional or epigenetic causes. Accordingly, the journal Birth Defects Research takes an integrated, multidisciplinary approach in its organization and publication strategy. The journal Birth Defects Research contains separate sections for clinical and molecular teratology, developmental and reproductive toxicology, and reviews in developmental biology to acknowledge and accommodate the integrative nature of research in this field. Each section has a dedicated editor who is a leader in his/her field and who has full editorial authority in his/her area.
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