Inpatient Hospitalization Costs Associated With Birth Defects Among Persons Aged <65 Years

Abbreviations: ICD-10-CM = International Classification of Diseases, Tenth Revision, Clinical Modification; USD = U.S. dollars.
*Identified by scanning up to 40 available fields for ICD-10-CM diagnosis codes Q00–Q99: congenital malformations, deformations, and chromosomal abnormalities. Patent ductus arteriosus (Q25.0) and atrial septal defect (Q21.1) were not considered birth defects when occurring in neonates aged <28 days or with an associated indicator of preterm birth (ICD-10-CM codes P07.2 or P07.3). An additional 23 conditions of lesser clinical importance classified within the Q00–Q99 code range were not considered birth defects.
^†Birth defects categories correspond to blocks of ICD-10-CM diagnosis codes: cardiovascular (Q20–Q28), central nervous system (Q00–Q07), chromosomal (Q90–Q99), cleft lip/palate (Q35–Q37), ear (Q16–Q17), eye (Q10–Q15), gastrointestinal (Q38–Q45), genitourinary (Q50–Q64), integumentary (Q80–Q85), musculoskeletal (Q65–Q79), and other syndrome (Q87). "Other defect" includes birth defects of the face and neck (Q18), respiratory system (Q30–Q34), and other congenital malformations (Q86 and Q89). Critical cardiovascular defects (https://www.cdc.gov/ncbddd/heartdefects/facts.html) were operationalized using the National Birth Defects Prevention Network Congenital Malformations Surveillance Report (https://www.nbdpn.org/docs/Birth_Defects_Data_and_Directory_2022.pdf). The specific defects included are only those defined in the National Birth Defects Prevention Network Congenital Malformations Surveillance Report; birth defects not included contribute to frequencies and costs aggregated by birth defect category and overall. Because a single hospitalization might include more than one specific birth defect, individual birth defect frequencies might sum to >100% of birth defects categories or overall frequencies, and mean costs multiplied by frequencies will correspondingly sum to >100% of total costs.

Abbreviations: CNS = central nervous system; GI = gastrointestinal; ICD-10-CM = International Classification of Diseases, Tenth Revision, Clinical Modification; MS = musculoskeletal; USD = U.S. dollars.
*Identified by scanning up to 40 available diagnosis code fields for ICD-10-CM diagnosis codes Q00–Q99: congenital malformations, deformations, and chromosomal abnormalities.
^†Birth defects categories correspond to blocks of ICD-10-CM diagnosis codes: cardiovascular (Q20–Q28), CNS (Q00–Q07), chromosomal (Q90–Q99), cleft lip/palate (Q35–Q37), ear (Q16–Q17), eye (Q10–Q15), GI (Q38–Q45), genitourinary (Q50–Q64), integumentary (Q80–Q85), MS (Q65–Q79), and other syndrome (Q87). "Other defect" includes birth defects of the face and neck (Q18), respiratory system (Q30–Q34), and other congenital malformations (Q86 and Q89). Critical cardiovascular defects (https://www.cdc.gov/ncbddd/heartdefects/facts.html) were operationalized using the National Birth Defects Prevention Network Congenital Malformations Surveillance Report (https://www.nbdpn.org/docs/Birth_Defects_Data_and_Directory_2022.pdf). The specific defects included are only those defined in the National Birth Defects Prevention Network Congenital Malformations Surveillance Report; birth defects not included here contribute to frequencies and costs aggregated by birth defect category and overall.
^§Because a single hospitalization might include more than one specific birth defect, individual birth defect frequencies might sum to >100% of birth defects categories or overall frequencies, and mean costs multiplied by frequencies will correspondingly sum to >100% of total costs.
^¶For hospitalizations with any birth defect, the birth hospitalization costs include the costs for routine birth hospitalization.
**Cell sizes ≤10 were suppressed. Sums across all ages exclude suppressed cells.

Authors and Disclosures

Justin Swanson, MPH¹, Elizabeth C. Ailes, PhD², Janet D. Cragan, MD², Scott D. Grosse, PhD³, Jean Paul Tanner, PhD¹, Russell S. Kirby, PhD¹, Norman J. Waitzman, PhD⁴, Jennita Reefhuis, PhD² and Jason L. Salemi, PhD<sup>1

1</sup>Lawton and Rhea Chiles Center for Healthy Mothers and Babies, College of Public Health, University of South Florida, Tampa, Florida; ²Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC; ³Office of the Director, National Center on Birth Defects and Developmental Disabilities, CDC; ⁴Department of Economics, University of Utah, Salt Lake City, Utah.

Corresponding author
Justin Swanson, jswanson1@usf.edu.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Russell S. Kirby holds the Marrell endowed chair at the University of South Florida, College of Public Health and serves on the board of directors for the National Birth Defects Prevention Network. Jason L. Salemi and Jean Paul Tanner report grant support to the Florida Department of Health, subcontracted to the University of South Florida, for Advancing Population-based Surveillance of Birth Defects. No other potential conflicts of interest were disclosed.

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Summary

What is already known about this topic?

Estimates of birth defect–associated hospitalization costs must be updated as detection, diagnosis, and treatment evolve for numerous birth defects.

What is added by this report?

During 2019, among patients aged <65 years, 4.1% of all hospitalizations and 7.7% of related inpatient medical costs were associated with birth defects. The total estimated cost of birth defect–associated hospitalizations was $22.2 billion.

What are the implications for public health practice?

These updated estimates of hospitalization costs illustrate the importance of continually determining the health care needs of persons with birth defects to ensure optimal health for all.