Improved survival among children with spina bifida in the United States

Abstract

Objective: To evaluate trends in survival among children with spina bifida by race/ethnicity and possible prognostic factors in 10 regions of the United States.

Study design: A retrospective cohort study was conducted of 5165 infants with spina bifida born during 1979-2003, identified by 10 birth defects registries in the United States. Survival probabilities and adjusted hazard ratios were estimated for race/ethnicity and other characteristics using the Cox proportional hazard model.

Results: During the study period, the 1-year survival probability among infants with spina bifida showed improvements for whites (from 88% to 96%), blacks (from 79% to 88%), and Hispanics (from 88% to 93%). The impact of race/ethnicity on survival varied by birth weight, which was the strongest predictor of survival through age 8. There was little racial/ethnic variation in survival among children born of very low birth weight. Among children born of low birth weight, the increased risk of mortality to Hispanics was approximately 4-6 times that of whites. The black-white disparity was greatest among children born of normal birth weight. Congenital heart defects did not affect the risk of mortality among very low birth weight children but increased the risk of mortality 4-fold among children born of normal birth weight.

Conclusions: The survival of infants born with spina bifida has improved; however, improvements in survival varied by race/ethnicity, and blacks and Hispanics continued to have poorer survival than whites in the most recent birth cohort from 1998-2002. Further studies are warranted to elucidate possible reasons for the observed differences in survival.

Copyright © 2012 Mosby, Inc. All rights reserved.

Figures

Figure 1

Kaplan-Meier survival curves for children born with spina bifida by race/ethnicity, 1983-2003.

Figure 2

Kaplan-Meier survival curves for children born with spina bifida by birth cohort, 1983-2003.

Figure 3

Trends in survival probability to 1 year by race/ethnicity (GA [5 metropolitan Atlanta counties], CA [11 counties], IA, NY [New York City excluded]: non-Hispanic white 1543, non-Hispanic black 205, Hispanic 951) and birth cohort in 4 regions during 1983-2002. P values for increasing trend based on an unadjusted proportional hazard model.