Risk Factors for Inpatient Mortality in Patients Born with Gastroschisis in the United States

Abstract

Objective To characterize risk factors for inpatient mortality in patients born with gastroschisis in a contemporary cohort. Study Design This was a retrospective cohort study of infants born with gastroschisis using the Kids' Inpatient Database 2016. Simple descriptive statistics were used to characterize the patients by demographics, and illness severity was estimated using the All-Patient Refined Diagnosis-Related Groups classification. Variables associated with an increased risk of mortality on univariate analysis were incorporated into a multivariable logistic regression model to generate adjusted odds ratios (aORs) for mortality. Results An estimated 1,990 patient with gastroschisis were born in 2016, with a 3.7% mortality rate during the initial hospitalization. Multivariable logistic regression demonstrated the following variables to be associated with an increased risk of inpatient mortality: black or Asian race compared with white (aOR: 2.6, 95% confidence interval [CI]: 1.1–6.1, p = 0.03 and aOR: 4.1, 95% CI: 1.3–13.3, p = 0.02, respectively), whereas private health insurance compared with government (aOR: 0.2; 95% CI: 0.2–0.8; p = 0.007) and exurban domicile compared with urban (aOR: 0.5; 95% CI: 0.2–0.9; p = 0.04) appeared to be associated with a decreased risk of inpatient mortality. Conclusion Inpatient mortality for neonates with gastroschisis is relatively low. Even after correcting for illness severity, race, health insurance status, and domicile appear to play a role in mortality disparities. Opportunities may exist to further decrease mortality in at-risk populations.