Perinatal & Pediatric
Cumulative Incidence of Medical Complexity through Early Childhood and Associations with Birth Outcomes in a U.S. Military Birth Cohort Jackielyn Lanning* Jackielyn Lanning Clinton Hall Celeste J. Romano Anna T. Bukowinski Gia R. Gumbs Jordan A. Taylor Sarah Craig Monica A. Lutgendorf A. James O’Malley Elizabeth M. Perkins David C. Goodman Ava Marie S. Conlin JoAnna K. Leyenaar
Background: Children with medical complexity (CMC) have one or more chronic medical conditions that impact daily living. While CMC represent a small proportion of the pediatric population, they experience a disproportionate fraction of medical care and costs. This study estimated the cumulative incidence of CMC by age 60 months in a cohort of live births among United States military families and measured associations between CMC and birth outcomes.
Methods: Department of Defense Birth and Infant Health Research program data captured births among military families, 2005-2015. Healthcare claims through 60 months of age identified CMC using two validated algorithms: the Pediatric Medical Complexity Algorithm and the Complex Chronic Condition Classification System. Birth characteristics were compared by CMC status. Accounting for death as a competing event and loss to follow-up, the cumulative incidence of CMC by age 60 months was estimated and Fine-Gray regression models calculated adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for associations of CMC with birth outcomes.
Results: Overall, 980,246 live births were identified and the estimated cumulative incidence of CMC by age 60 months (n=104,077) was 11.3% (95% CI=11.3-11.4). CMC were more likely to be delivered by cesarean section (36.9 vs 27.4%) and have intensive neonatal care (23.0 vs 3.6%) than children without medical complexity. Hazard of CMC was highest for children born with vs without congenital anomalies (aHR=26.4; 95% CI=25.6-27.2), very preterm (<32 weeks’ gestation) vs term (aHR=2.5; 95% CI=2.4-2.5), and very low birthweight (<1500 grams) vs normal birthweight (aHR=14.4; 95% CI=13.9-14.8).
Conclusions: Approximately 1 in 10 military children developed medical complexity by age 5; understanding the burden of CMC in this population can guide future research and planning of services. Adverse birth outcomes were highly associated with risk of medical complexity through early childhood.
Disclaimer: Dr. Ava Marie S. Conlin, Dr. Monica A. Lutgendorf, and Dr. Elizabeth M. Perkins are military service members or employees of the U.S. Government. This work was prepared as part of their official duties. Title 17, U.S.C. §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C. §101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. This work was supported by U.S. Navy Bureau of Medicine and Surgery under work unit no. 60504. The views expressed in this research are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences (USUHS), Department of the Navy, Department of Defense, nor the U.S. Government. The study protocol was approved by the Naval Health Research Center Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Research data were derived from approved Naval Health Research Center Institutional Review Board protocol number NHRC.1999.0003.