Alaska Birth Defects Registry Condition Report
Congenital Diaphragmatic Hernia (CDH)
Alaska, 2007-2016
Background
Congenital diaphragmatic hernia (CDH) is a birth defect where a hole in the diaphragm allows for the passage of organs in the abdomen, such as the intestines, stomach, and liver, upwards into an infant’s chest.[1] The diaphragm is the large muscle that separates the chest from abdomen and when an organ in the abdomen pushes through the hole in the diaphragm, it is considered a hernia. The presence of these organs in the chest can cause breathing difficulties and prevent the infant’s lungs from developing completely.[1] CDHs can be diagnosed before the infant is born through an ultrasound. If the defect is not found before birth, doctors may diagnose the condition through a chest x-ray and presence of symptoms, like difficulty breathing after the baby is born.[2] Treatment requires surgery soon after birth to repair the hernia and continued breathing assistance is often necessary to help the lungs recover and fully develop.
The exact causes of CDH are unknown, although increasing evidence points to genetic causation. Some research has shown that about 15-20% of all CDH cases are caused by abnormalities in the infant’s genes, but the causes of the remaining 80-85% of CDH cases are unknown.[3]
Epidemiology
Alaska Birth Defects Registry (ABDR) registers birth defects as reported from health care providers using International Classification of Disease (ICD) billing codes. The use of these ICD codes can lead to misclassification of diagnosed conditions. Prior to this report, all prevalence estimates were based on the number of unique children reported to ABDR with an ICD code representing a specified condition regardless of case confirmation status.
The estimates in this report were derived by conducting medical record review and case confirmation of a random sample of cases of the condition reported to ABDR. The confirmation probability from the sample was used to develop informed estimates of the actual diagnosed defect prevalence. See Defect prevalence calculation.
For explanations of table columns see Column descriptions.
Prevalence
Congenital diaphragmatic hernia occurs in 2.5 out of every 10,000 live births in the United States. [1]
In Alaska, during 2007-2016, the prevalence of congenital diaphragmatic hernia was 3.8 per 10,000 live births.| Reports | Defects | Births | Prevalence (95% CI) | |
|---|---|---|---|---|
| Total | 53 | 43.5 | 113183 | 3.8 (2.8, 5.1) |
| Notes: 95% CI = 95% Confidence Interval | ||||
Trend
Prevalence per 10,000 births of congenital diaphragmatic hernia during 2007-2016 by three-year moving averages, with 95% confidence interval band and Poisson estimated fitted line.
| Reports | Defects | Births | Prevalence (95% CI) | Predicted Prevalence† | |
|---|---|---|---|---|---|
| 2007-2009 | 8.0 | 6.3 | 11262.0 | 5.5 (2.3, 11.2) | 5.4 |
| 2008-2010 | 7.0 | 5.6 | 11404.3 | 4.9 (2.0, 10.2) | 4.9 |
| 2009-2011 | 5.7 | 4.6 | 11404.7 | 4.0 (1.6, 9.4) | 4.4 |
| 2010-2012 | 5.0 | 4.1 | 11354.0 | 3.6 (1.3, 8.6) | 4.0 |
| 2011-2013 | 5.7 | 4.6 | 11348.7 | 4.0 (1.4, 9.0) | 3.6 |
| 2012-2014 | 5.3 | 4.4 | 11334.3 | 3.8 (1.3, 8.6) | 3.3 |
| 2013-2015 | 4.3 | 3.7 | 11377.0 | 3.2 (1.0, 7.7) | 3.0 |
| 2014-2016 | 2.7 | 2.5 | 11295.0 | 2.2 (0.6, 6.4) | 2.7 |
|
Notes: Each row is based on three-year moving averages; Prevalence reported per 10,000 live births; 95% CI=95% Confidence Interval † Estimated rate based on Poisson model |
|||||
| Estimate | Std. Error | t value | Pr(>|t|) |
|---|---|---|---|
| -0.09813 | 0.01888 | -5.19625 | 0.00202 |
Regional Distribution
Distribution of congenital diaphragmatic hernia in Alaska by Public Health Region of maternal residence at the time of birth. A description of regional breakdowns can be found here. Data suppressed for # of reports < 6.
| Reports | Defects | Births | Prevalence (95% CI) | |
|---|---|---|---|---|
| Anchorage | 17 | 14.5 | 46323 | 3.1 (1.8, 5.1) |
| Gulf Coast | - | - | 7048 | - |
| Interior | - | - | 20523 | - |
| Mat-Su | 7 | 5.7 | 13587 | 4.2 (1.6, 8.6) |
| Northern | - | - | 7812 | - |
| Southeast | - | - | 7012 | - |
| Southwest | 16 | 11.9 | 10878 | 10.9 (5.7, 18.1) |
| Notes:Prevalence reported per 10,000 live births; Data suppressed for # of reports < 6; 95% CI = 95% Confidence Interval | ||||
Demographics
Some subgroups may be more at risk for having a baby with congenital diaphragmatic hernia. This section provides the descriptive epidemiology of specified maternal, birth, and child characteristics identified from the birth certificate.
| Reports | Defects | Births | Prevalence (95% CI) | |
|---|---|---|---|---|
| Sex | ||||
| Female | 24 | 19.9 | 54900 | 3.6 (2.2, 5.4) |
| Male | 29 | 23.6 | 58283 | 4.0 (2.6, 5.9) |
| Birth weight (grams) | ||||
| <2500 | 12 | 8.8 | 6582 | 13.4 (6.2, 24.0) |
| 2500+ | 41 | 34.6 | 106420 | 3.3 (2.3, 4.5) |
| Maternal age | ||||
| 12-19 | 10 | 7.5 | 8664 | 8.7 (4.0, 16.6) |
| 20-24 | 13 | 10.8 | 30607 | 3.5 (1.8, 6.0) |
| 25-29 | 12 | 10.3 | 34376 | 3.0 (1.6, 5.3) |
| 30-34 | 10 | 8.4 | 25418 | 3.3 (1.6, 6.2) |
| 35-39 | - | - | 11311 | - |
| 40+ | - | - | 2778 | - |
| Maternal race | ||||
| Alaska Native/American Indian | 32 | 24.2 | 28829 | 8.4 (5.6, 12.4) |
| Asian/Pacific Islander | - | - | 10598 | - |
| Black | - | - | 4581 | - |
| White | 20 | 17.7 | 67675 | 2.6 (1.6, 4.0) |
| Maternal education (years) | ||||
| <12 | 8 | 6.2 | 10904 | 5.7 (2.6, 12.0) |
| 12 | 15 | 12.7 | 40057 | 3.2 (1.7, 5.2) |
| 12+ | 29 | 23.6 | 58944 | 4.0 (2.6, 5.8) |
| Marital status | ||||
| Married | 23 | 20.1 | 71658 | 2.8 (1.8, 4.3) |
| Unmarried | 30 | 23.4 | 41006 | 5.7 (3.8, 8.4) |
| Maternal smoking use | ||||
| Reported smoking | 11 | 8.6 | 15727 | 5.5 (2.6, 10.0) |
| Reported not smoking | 38 | 31.9 | 95579 | 3.3 (2.3, 4.6) |
| Medicaid (mother or child) | ||||
| Medicaid | 38 | 29.9 | 57258 | 5.2 (3.5, 7.3) |
| non-Medicaid | 15 | 13.6 | 55806 | 2.4 (1.4, 4.0) |
| Father on birth certificate | ||||
| None | 6 | 4.5 | 5634 | 8.1 (2.9, 18.2) |
| Present | 47 | 39 | 107549 | 3.6 (2.6, 4.8) |
| Notes: Prevalence reported per 10,000 live births; Data suppressed for # of reports < 6; 95% CI = 95% Confidence Interval | ||||
Technical notes
Column descriptions
# Reports: Unless otherwise noted, the number of unique reports of the defect received by ABDR during the specified birth year(s). Each report represents a unique child with the specified defect.
# Defects: The estimated true number of reports that are diagnosed defects based on medical record review and case confirmation.
# Births: The number of live births among Alaskan residents that occurred in Alaska during the specified birth year(s).
Prevalence (95% CI): The estimated diagnosed prevalence of the condition and corresponding 95% Confidence Interval. (For information on how the defect prevalence was estimated see below).
Defect prevalence calculation
The estimated defect prevalence was calculated using a Bayesian approach based on the reported prevalence, PPV and 1-NPV (see formula below).
Through medical records review and case confirmation of a random sample of reported cases, the defect prevalence is calculated as:
\[PPV (Positive Predictive Value) = p(defect|report)\] \[NPV (Negative Predictive Value) = p(\overline{defect}|\overline{report})\]
\[p(defect) \approx [p(report)\cdot PPV]+[p(\overline{report})\cdot (1-NPV)]\]
Defect prevalence estimates are a more accurate estimation of the actual diagnosed prevalance of birth defects compared to the reported prevalance estimates in Alaska. ABDR obtains reports from medical providers using International Classification of Disease (ICD) codes that are extracted from individual systems which when aggregated may not reflect true diagnostics. Caution should be used when interpreting and comparing the reported prevalence estimates with national estimates.
See Data analysis methods for more information.
P-value estimate
To evaluate the trend over time and account for under/over-dispersion we constructed a quasi-Poisson regression model. This model assumes the variance is a linear function of the mean and models the estimated number of annual defects by year with a natural log (ln) offset of the annual births. P-values < 0.05 are considered significant, which indicates that the predicted slope is significantly different from a slope of zero.
Data suppression
For region and demographic data tables, values are suppressed based on the number of reports received during the observation period. Counts less than 6 are suppressed (as indicated by ‘-’ in the table). For regions or demographics with only one cell count suppressed a second is suppressed to eliminate the ability to back-calculate the estimate.
References
[1]Centers for Disease Control and Prevention. Facts about Diaphragmatic Hernia, https://www.cdc.gov/ncbddd/birthdefects/diaphragmatichernia.html#ref; 2017 [accessed 08.29.2017]
[2] Tovar JA. Congenital diaphragmatic hernia. Orphanet Journal of Rare Disease. 2012; 7(1)
[3] Pober BR, Russell MK, Ackerman KG. Congenital diaphragmatic hernia overview. 2006 [Updated 2010 Mar 16]. GeneReviews. Available at: http://www.ncbi.nlm.nih.gov/books/NBK1359/
Resources
Centers for Disease Control and Prevention
Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS)
National Birth Defects Prevention Network
Suggested Citation
State of Alaska Department of Health and Social Services, Division of Public Health, Section of Women’s, Children’s, and Family Health. Alaska Birth Defects Registry Condition Report: Congenital Diaphragmatic Hernia (CDH), Alaska, 2007-2016. Updated July 23, 2020. Available at: http://rpubs.com/AK_ABDR/CongenitalDiaphragmaticHernia07_16.
Contact
Alaska Birth Defects Registry (ABDR)
3601 C Street, Suite 358
Anchorage, AK 99503
(907) 269-3400 phone
(907) 754-3529 fax
hssbirthdefreg@alaska.gov
Updated: July 23, 2020
Code source: R:\ABDR\Analysis_New\ABDR_CASECONF\cond_reports\Published_reports\DiaphragmaticHernia07_16.Rmd
