Elsevier

Journal of Pediatric Surgery

Volume 53, Issue 12, December 2018, Pages 2399-2403
Journal of Pediatric Surgery

Neonatal
Epidemiology of gastroschisis: A population-based study in California from 1995 to 2012

https://doi.org/10.1016/j.jpedsurg.2018.08.035Get rights and content

Abstract

Background

Although the incidence of gastroschisis is increasing, risk factors are not clearly identified.

Methods

Using the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995 to 2012, patients with gastroschisis were identified by ICD-9 diagnosis/procedure code or birth certificate designation. Logistic regressions examined demographics, birth factors, and maternal exposures on risk of gastroschisis.

Results

The prevalence of gastroschisis was 2.7 cases per 10,000 live births. Patients with gastroschisis had no difference in fetal exposure to alcohol (p = 0.609), narcotics (p = 0.072), hallucinogenics (p = 0.239), or cocaine (p = 0.777), but had higher exposure to unspecified/other noxious substances (OR 3.27, p = 0.040; OR 2.02, p = 0.002). Gastroschisis was associated with low/very low birthweight (OR 5.08–16.21, p < 0.001) and preterm birth (OR 3.26–10.0, p < 0.001). Multivariable analysis showed lower risk in black (OR 0.44, p < 0.001), Asian/Pacific Islander (OR 0.76, p = 0.003), and Hispanic patients (OR 0.72, p < 0.001) compared to white patients. Risk was higher in rural areas (OR 1.24–1.76, p = 0.001). Compared to women age < 20, risk decreased with advancing maternal age (OR 0.49-OR 0.03, p < 0.001). Patients with gastroschisis had increased total charges ($336,270 vs. $9012, p < 0.001) and length of stay (38.1 vs. 2.9 days, p < 0.001). Mortality was 4.6%.

Conclusions

This is the largest population-based study summarizing current epidemiology of gastroschisis in California.

Type of study

Retrospective comparative cohort study.

Level of evidence

III.

Section snippets

Materials and methods

This is a retrospective, observational population analysis using data from the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995 to 2012. This database includes information on all births in California, including infant birth records and readmissions within one year as well as maternal antepartum and postpartum hospital records. It links information from the following datasets: California Patient Discharge Data, Vital Statistics Birth/Death

Results

From 1995 to 2012, 2527 infants with gastroschisis were born in California, resulting in a population prevalence of 2.7 cases per 10,000 live births during the study timeframe (Table 1). The prevalence increased during this time period from 1.5 to 5.3 cases per 10,000 live births.

Discussion

The prevalence of gastroschisis in California from 1995 to 2012 was 2.7 cases per 10,000 live births, but has increased during this time period from 1.5 to 5.3 cases per 10,000 live births. The increasing prevalence in California is concordant with ongoing concerns of a worldwide increase in the prevalence of gastroschisis [1], [2], [3], [4], [5], [6], [7].

The highest risk in California continues to be among mothers who are white, young, and live in rural areas. Although mothers of Hispanic

Acknowledgments

The California Office of Statewide Health Planning and Development and the hospitals participating in the Linked Birth and Patient Discharge Database are the source of data used herein. These entities and hospitals have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Funding: This research was funded in part by the UC Davis Department of Surgery Outcomes Research Group.

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