Reduction of infant mortality from congenital heart defects in a middle-income country: Costa Rican experience.

Autor: Benavides-Lara A; Costa Rican Birth Defects Register Center (CREC), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica., Barboza-Argüello MP; Costa Rican Birth Defects Register Center (CREC), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica., Arguedas-Arguedas O; Hospital Nacional de Niños 'Dr. Carlos Sáenz Herrera', Caja Costarricense del Seguro Social, San José, Costa Rica., Faerron-Angel JE; Hospital Nacional de Niños 'Dr. Carlos Sáenz Herrera', Caja Costarricense del Seguro Social, San José, Costa Rica., da Cruz EM; Children's Hospital Colorado, Aurora, Colorado, USA.; University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
Jazyk: angličtina
Zdroj: Birth defects research [Birth Defects Res] 2022 Dec 01; Vol. 114 (20), pp. 1364-1375. Date of Electronic Publication: 2022 Sep 29.
DOI: 10.1002/bdr2.2093
Abstrakt: Background: We aimed to analyze recent infant and neonatal mortality from congenital heart defects (CHD) in Costa Rica, a middle-income country where CHD mortality was above expectations.
Methods: A descriptive analysis of infant and neonatal mortality rates from CHD (IMR-CHD and NMR-CHD) during 2000-2019 was performed, according to province, sex, specific CHD, and sub-period, using data from the National Institute of Statistics and Censuses. We used joinpoint regression to identify any calendar-year where a significant change in trend occurred; the average annual percent change (AAPC) was determined. Using Poisson regression, marginal means and mortality ratios (MR) for IMR-CHD and NMR-CHD by sub-period (2000-2006-referent-, 2007-2013, 2014-2019) were estimated and compared using Wald's chi-square tests (α ≤ .05).
Results: During 2000-2019, CHD accounted for 12% of overall infant mortality. IMR-CHD and NMR-CHD decreased linearly over the study period (AAPC = -3.4; p < .01). IMR-CHD decreased by 41%, from 13.6 per 10,000 in 2000-2006 (13.4% of infant mortality) to 8.1 per 10,000 in 2014-2019 (10% of infant mortality) (MR = 0.59; 95% confidence intervals [CI] = 0.52-0.68). NMR-CHD decreased by 38%, from 7.9 per 10,000 in 2000-2006 (11.1% of neonatal mortality) to 4.9 per 10,000 in 2014-2019 (7.9% of infant mortality) (MR = 0.59; 95% CI = 0.52-0.68). Male presented significantly higher NMR-CHD. The main causes of mortality (2014-2019) were total anomalous pulmonary venous connections, hypoplastic left heart syndrome, and double inlet ventricle.
Conclusions: IMR-CHD, NMR-CHD, and their proportional contribution to mortality by all causes and by birth defects decreased significantly, demonstrating that all improvements implemented in the last decades have yielded favorable results.
(© 2022 Wiley Periodicals LLC.)
Databáze: MEDLINE
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