Inpatient Hospitalization Costs Associated with Birth …

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; Jason L. Salemi, PhD1 (View author affiliations)

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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.

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Abstract

Changing treatments and medical costs necessitate updates to hospitalization cost estimates for birth defects. The 2019 National Inpatient Sample was used to estimate the service delivery costs of hospitalizations among patients aged <65 years for whom one or more birth defects were documented as discharge diagnoses. In 2019, the estimated cost of these birth defect–associated hospitalizations in the United States was $22.2 billion. Birth defect–associated hospitalizations bore disproportionately high costs, constituting 4.1% of all hospitalizations among persons aged <65 years and 7.7% of related inpatient medical costs. Updating estimates of hospitalization costs provides information about health care resource use associated with birth defects and the financial impact of birth defects across the life span and illustrates the need to determine the continued health care needs of persons born with birth defects to ensure optimal health for all.

Introduction

In the United States, major structural birth defects attributable to genetic, chromosomal, teratogenic, or unknown etiologies affect approximately 3% of live births (1) and are the leading cause of infant mortality, responsible for 21% of newborn and infant deaths (2). Their treatments incur significant financial costs throughout a person’s lifetime. As treatments and medical costs change, updates to hospitalization cost estimates for birth defects are needed.

Methods

Developed for the Healthcare Cost and Utilization Project (HCUP), the National Inpatient Sample (NIS) is the largest publicly available, all-payor inpatient care database in the United States.* NIS uses a 20% systematic sampling of all discharges from short-term, nonfederal community hospitals. Because NIS does not identify patients across multiple hospital visits, the unit of analysis for this study is individual hospitalization rather than individual patient. To reduce the impact of potential miscoding of age-related abnormalities as birth defects (particularly cardiovascular defects) (3), only patients aged <65 years discharged during January 1–December 31, 2019 were included. Birth hospitalizations were determined separately from other hospitalizations during the first year of life to better differentiate the costs of birth defects from routine delivery costs. Records missing values of age or billed charges were excluded. Sampling weights for the remaining hospitalizations were adjusted to retain total hospitalization frequency and cost.

Cost estimates were calculated as the product of the amount billed for a hospitalization and the corresponding hospital-level cost-to-charge ratios. HCUP-provided cost-to-charge ratios are computed on an annual basis for each hospital (total institutional service delivery costs divided by total amount charged by the hospital). NIS records facility charges but not professional fees charged by physicians who are not hospital employees.

Birth defects were identified by scanning up to 40 available diagnosis code fields associated with each hospitalization among codes Q00–Q99 (congenital malformations, deformations, and chromosomal abnormalities) of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). 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 (P07.2 or P07.3). In addition, 23 conditions classified within the Q00–Q99 code range that are commonly considered benign or are otherwise unlikely to contribute to hospitalization costs were not considered birth defects for the purposes of this analysis (Supplementary Table, https://stacks.cdc.gov/view/cdc/130207).

Sampling weights were applied to calculate national estimates of hospitalization frequency and cost. Mean, median, and total costs were calculated by patient demographic and birth defect code characteristics. Mean hospitalization costs were stratified by age group for selected individual birth defects and birth defect categories. If a hospitalization was associated with more than one defect included in the table, the full cost of the hospitalization was included for each defect. The individual birth defects listed include those defined in the National Birth Defects Prevention Network Congenital Malformations Surveillance Report.§ Statistical analyses were performed using SAS software (version 9.4; SAS Institute) with survey procedures incorporating sampling design. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.

Results

During 2019, a total of 937,295 birth defect–associated hospitalizations incurred a total cost of $22,204,754,855 (Table 1), representing 4.1% of hospitalizations and 7.7% of hospitalization costs among persons in the United States aged <65 years. A birth defect code was the principal diagnosis code for 15.8% of all birth defect–associated hospitalizations that were not birth hospitalizations.

Nonbirth hospitalizations of persons aged $150,000 included esophageal atresia ($214,651), interrupted aortic arch ($199,973), and diaphragmatic hernia ($195,456) (Table 2). Although mean costs per nonbirth hospitalization were highest for patients aged <1 year, this was not consistent across individual birth defects (Table 2) (Figure). Overall, nearly one third of hospitalization costs occurred among patients aged 19–64 years (Table 1).

Discussion

During 2019, the cost of hospitalizations for persons aged <65 years with a birth defect diagnosis code was estimated at $22.2 billion. These hospitalizations were associated with disproportionately high costs, constituting 4.1% of all hospitalizations among persons in the United States aged <65 years and 7.7% of total costs. Nearly one half of hospitalization costs associated with birth defects occurred among neonates and infants, and these costs disproportionately affected persons aged <1 year during nonbirth hospitalizations. Defects of the cardiovascular system were the most prevalent birth defects, were associated with disproportionately high ($9.8 billion) hospitalization costs, and included many of the costliest individual birth defects.

Using 2013 NIS data, the total cost of birth defect–associated hospitalizations was estimated to be $22.9 billion for all ages and $19.1 billion for persons aged <65 years (4). Those estimates included adjustments for professional fees, which historically added 20%–25% to facility costs (5). Applying the same adjustments to the current estimates yields a 2019 estimate of $26.6–27.8 billion in total birth defect–associated hospitalization costs for persons aged <65 years. When adjusted to 2019 hospital care prices, the 2013 cost estimate is $21.0 billion for persons aged <65 years.** The share of birth defect–associated expenditures among total hospitalization expenditures was similar among all age groups: 5.2% in 2013 and 5.5% in 2019.

Limitations

The findings in this report are subject to at least five limitations. First, determining which costs are directly attributable to birth defects is challenging because of difficulties in identifying all sequelae of birth defects and their respective codes, the coding of minor birth defects, and the possible miscoding of some acquired structural or functional abnormalities as birth defects (3). Excluding hospitalizations for persons aged ≥65 years reduces the risk for miscoding but fails to identify the contribution of birth defects among this age group. Second, the potential for two or more birth defects to be documented during the same hospitalization could lead to overestimation of costs for findings presented by individual defect or category. Third, cost-to-charge ratios calculated at the hospital level do not necessarily accurately reflect the costs of different types of hospital services (6), which could bias estimates of a person’s hospitalization costs in an unknown direction. Fourth, HCUP costs are limited to facility fees and fail to include physician or professional fees, thereby underestimating birth defect–associated hospitalization costs. Finally, it is difficult to distinguish the relationship between preterm birth and birth defects, and some of the birth defect–associated costs among preterm infants were possibly due to their prematurity rather than their birth defect.

Implications for Public Health Practice

Updated estimates of hospitalization costs for specific birth defects provide critical information about health care resource use. These data highlight the financial impact across the life span and illustrate the need to understand the continued health care needs of persons born with birth defects to ensure optimal health for all.


1Lawton 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.


References

  1. CDC. Update on overall prevalence of major birth defects—Atlanta, Georgia, 1978–2005. MMWR Morb Mortal Wkly Rep 2008;57:1–5. PMID:18185492
  2. Ely DM, Driscoll AK. Infant mortality in the United States, 2019: data from the period linked birth/infant death file. Natl Vital Stat Rep 2021;70:1–18. https://doi.org/10.15620/cdc:111053 PMID:34878382
  3. Rodriguez FH 3rd, Raskind-Hood CL, Hoffman T, et al. How well do ICD-9-CM codes predict true congenital heart defects? A Centers for Disease Control and Prevention–based multisite validation project. J Am Heart Assoc 2022;11:e024911. https://doi.org/10.1161/JAHA.121.024911 PMID:35862148
  4. Arth AC, Tinker SC, Simeone RM, Ailes EC, Cragan JD, Grosse SD. Inpatient hospitalization costs associated with birth defects among persons of all ages—United States, 2013. MMWR Morb Mortal Wkly Rep 2017;66:41–6. https://doi.org/10.15585/mmwr.mm6602a1 PMID:28103210
  5. Peterson C, Xu L, Florence C, Grosse SD, Annest JL. Professional fee ratios for US hospital discharge data. Med Care 2015;53:840–9. https://doi.org/10.1097/MLR.0000000000000410 PMID:26340662
  6. Salemi JL, Comins MM, Chandler K, Mogos MF, Salihu HM. A practical approach for calculating reliable cost estimates from observational data: application to cost analyses in maternal and child health. Appl Health Econ Health Policy 2013;11:343–57. https://doi.org/10.1007/s40258-013-0040-2 PMID:23807539
TABLE 1. Weighted national estimates of frequencies and costs of hospitalizations with at least one birth defect–associated discharge diagnosis* among persons aged <65 years, by selected characteristics — National Inpatient Sample, United States, 2019Return to your place in the text
Characteristic No. of discharges (%) Total cost, USD (%) Mean cost, USD Median cost, USD
All hospitalizations
with a birth defect diagnosis
937,295 (100.0) 22,204,754,855 (100.0) 23,690 7,054
Position of birth defect diagnosis code, excluding birth hospitalizations (N = 583,665)
Principal diagnosis 92,200 (15.8) 4,628,169,299 (26.7) 50,197 21,837
Not principal diagnosis 491,465 (84.2) 12,734,760,311 (73.3) 25,912 10,693
Age group at admission, yrs
Birth 353,630 (37.7) 4,841,825,245 (21.8) 13,692 1,668
<1, nonbirth 97,085 (10.4) 6,007,670,516 (27.1) 61,881 15,708
1–5 70,405 (7.5) 2,010,690,220 (9.1) 28,559 11,495
6–18 84,330 (9.0) 2,406,631,722 (10.8) 28,538 13,745
19–64 331,845 (35.4) 6,937,937,152 (31.2) 20,907 11,050
Co-occurring preterm birth diagnosis code, first year of life only (N = 450,715)
Yes 69,145 (15.3) 4,982,419,450 (45.9) 72,058 23,567
No 381,570 (84.7) 5,867,076,311 (54.1) 15,376 1,865
Primary payer
Medicare/Medicaid 489,435 (52.2) 11,830,918,831 (53.3) 24,173 7,228
Private insurance 377,260 (40.2) 8,624,077,051 (38.8) 22,860 6,892
Self-pay/No charge 38,420 (4.1) 589,451,660 (2.7) 15,342 4,454
Other 30,810 (3.3) 1,131,579,789 (5.1) 36,728 10,309
Missing 1,370 (0.1) 28,727,525 (0.1) 20,969 8,138
Race or ethnicity
Black or African American, non-Hispanic 155,790 (16.6) 3,643,653,444 (16.4) 23,388 5,453
White, non-Hispanic 465,705 (49.7) 10,623,669,704 (47.8) 22,812 8,254
Hispanic or Latino, all races 159,090 (17.0) 4,176,577,475 (18.8) 22,752 6,770
Other race, non-Hispanic 99,905 (10.7) 2,468,402,379 (11.1) 26,253 5,128
Missing 56,805 (6.1) 1,292,451,853 (5.8) 24,707 3,550
Birth defects category
Cardiovascular 209,045 (22.3) 9,833,000,308 (44.3) 47,038 15,750
Cardiovascular, critical 32,380 (3.5) 2,810,676,170 (12.7) 86,803 29,430
Central nervous system 97,810 (10.4) 3,170,662,573 (14.3) 32,417 11,920
Chromosomal 81,450 (8.7) 2,629,174,588 (11.8) 32,280 10,393
Cleft lip or palate or both 13,450 (1.4) 371,907,278 (1.7) 27,651 9,457
Ear 16,505 (1.8) 311,185,562 (1.4) 18,854 1,979
Eye 7,020 (0.7) 353,579,767 (1.6) 50,367 13,268
Gastrointestinal 58,630 (6.3) 2,372,323,342 (10.7) 40,463 12,043
Genitourinary 190,550 (20.3) 3,827,722,973 (17.2) 20,088 5,702
Integumentary 185,165 (19.7) 1,968,999,140 (8.9) 10,634 1,587
Musculoskeletal 152,150 (16.2) 4,139,059,463 (18.6) 27,204 8,948
Other syndrome affecting multiple systems 29,050 (3.1) 1,040,175,603 (4.7) 35,806 12,161
Other defect 42,875 (4.6) 2,757,425,472 (12.4) 64,313 11,987

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.

TABLE 2. Weighted national estimates of frequencies and mean costs of birth defect–associated hospitalizations* among persons aged <65 years, by selected specific birth defect and age group — National Inpatient Sample, United States, 2019Return to your place in the text
Birth defect Age group at admission, yrs
Birth hospitalization <1, nonbirth 1–5 6–18 19–64 All age groups
No.§ Mean cost, USD No.§ Mean cost, USD No.§ Mean cost, USD No.§ Mean cost, USD No.§ Mean cost, USD No.§ Mean cost, USD
No defect 3,571,404 4,804 416,265 25,979 398,395 14,516 951,630 14,670 16,658,885 13,099 21,996,579 12,089
Any defect 353,630 13,692 97,085 61,881 70,405 28,559 84,330 28,538 331,845 20,907 937,295 23,690
Cardiovascular,
critical
5,965 79,481 11,440 128,700 5,380 79,335 3,770 63,332 5,825 34,105 32,380 86,803
Cardiovascular 40,095 46,527 41,690 85,846 21,490 45,754 15,720 44,526 90,050 30,043 209,045 47,038
Aortic valve
stenosis
340 73,405 490 119,278 110 27,810 280 61,876 1,370 41,825 2,590 62,196
Atrial septal
defect
—** —** 15,680 63,964 9,490 42,483 5,095 35,458 45,570 31,479 75,835 39,840
Atrioventricular
septal defect
1,180 104,798 2,820 117,756 1,030 60,301 515 52,148 520 27,665 6,065 92,182
Coarctation
of aorta
1,720 71,865 2,525 135,489 615 46,094 570 45,512 1,680 31,249 7,110 80,521
Common truncus 185 141,256 205 130,074 130 161,151 155 66,602 135 50,004 810 112,124
Dextro-transposition
of great arteries
855 83,149 1,295 170,533 480 79,142 310 55,015 660 37,539 3,600 103,264
Double outlet
right ventricle
805 111,159 1,640 127,862 1,110 77,471 490 78,043 315 77,532 4,360 102,714
Ebstein anomaly 170 77,141 285 95,984 300 46,389 225 64,109 750 27,301 1,730 51,611
Hypoplastic
left heart syndrome
915 121,117 2,075 150,444 1,470 73,969 945 92,979 380 74,707 5,785 112,011
Interrupted
aortic arch
115 102,776 320 199,973 95 77,770 60 69,036 25 10,323 615 142,438
Pulmonary valve
atresia
200 272,866 380 124,374 190 173,504 150 41,734 150 45,257 1,070 138,177
Single ventricle 340 155,126 1,010 166,406 750 66,991 485 61,920 515 42,193 3,100 104,135
Tetralogy of Fallot 1,365 73,218 3,050 117,165 920 126,979 735 52,117 1,210 29,541 7,280 89,034
Total anomalous
pulmonary venous
connection
270 106,042 760 189,531 230 55,991 115 65,213 75 21,751 1,450 134,265
Tricuspid valve atresia 300 92,262 660 81,529 430 83,806 205 53,565 440 24,579 2,035 68,462
Ventricular
septal defect
19,100 35,719 12,555 77,434 4,415 38,583 2,025 39,583 4,900 26,875 42,995 47,369
CNS 13,865 52,329 11,600 71,978 14,400 24,901 19,005 28,716 38,940 18,127 97,810 32,417
Anencephaly 255 3,502 —** —** 15 49,903 15 78,230 —** ** 285 9,877
Encephalocele 265 33,206 315 64,542 120 24,526 205 66,508 1,745 25,496 2,650 34,037
Holoprosencephaly 330 48,100 430 52,217 615 22,643 550 34,333 175 21,945 2,100 35,703
Spina bifida without anencephaly 880 45,169 1,250 64,401 1,675 18,846 4,675 25,621 21,140 15,491 29,620 20,225
Chromosomal 8,210 46,993 10,995 75,070 15,225 26,372 15,235 28,578 31,785 18,281 81,450 32,280
Trisomy 13 265 35,177 285 63,489 180 24,873 200 48,340 170 36,940 1,100 43,492
Trisomy 18 585 56,072 520 106,796 450 37,366 230 31,700 405 18,974 2,190 54,852
Trisomy 21 4,700 37,462 6,225 59,353 6,740 20,740 5,425 23,676 19,955 16,716 43,045 26,654
Turner syndrome 455 20,837 185 66,991 210 37,083 435 25,589 2,360 17,867 3,645 22,760
Cleft lip, palate, or both 4,595 20,809 4,205 44,472 2,225 20,661 1,640 17,551 785 18,513 13,450 27,651
Cleft lip
with cleft palate
1,965 23,733 1,805 49,534 795 17,313 1,000 15,135 340 20,581 5,905 29,118
Cleft lip
without cleft palate
915 5,896 450 15,407 50 10,883 60 13,972 80 8,569 1,555 9,258
Cleft palate
without cleft lip
1,715 25,414 1,950 46,493 1,380 22,944 580 22,086 365 18,765 5,990 30,980
Ear 13,050 10,005 1,715 77,822 710 31,595 715 26,105 315 19,229 16,505 18,854
Anotia or microtia 680 18,657 360 99,759 305 33,708 575 26,824 110 26,292 2,030 38,028
Eye 2,085 64,266 1,605 82,823 1,165 28,803 825 35,048 1,340 18,047 7,020 50,367
Anophthalmia or microphthalmia 255 68,830 345 66,729 210 20,661 130 34,154 160 16,837 1,100 47,315
Congenital cataract 235 24,404 190 61,187 160 41,027 135 22,791 265 11,517 985 30,511
GI 11,040 55,032 16,210 62,397 5,525 34,895 4,460 29,743 21,395 19,998 58,630 40,463
Biliary atresia 665 154,509 1,355 100,377 340 74,293 210 38,767 340 34,661 2,910 97,576
Esophageal atresia or tracheoesophageal
fistula
845 66,710 920 214,651 255 51,169 110 47,589 790 26,491 2,920 100,363
Rectal and large intestinal atresia or stenosis 1,310 57,601 2,415 65,145 860 21,769 345 20,196 370 16,827 5,300 49,943
Small intestinal atresia or stenosis 1,100 88,157 1,055 151,120 325 31,938 145 24,159 185 17,017 2,810 97,308
Genitourinary 80,320 14,354 15,555 68,294 8,385 26,362 8,450 22,150 77,840 15,472 190,550 20,088
Congenital posterior
urethral valves
220 55,495 565 73,936 325 28,558 365 32,728 130 42,875 1,605 50,332
Hypospadias 13,330 13,411 2,150 60,831 685 23,908 280 24,946 1,385 21,013 17,830 20,304
Renal agenesis
or hypoplasia
2,150 23,577 1,185 64,522 1,155 45,675 1,680 22,996 13,370 17,399 19,540 23,089
Integumentary 158,620 6,788 5,760 79,162 2,310 22,121 3,505 26,692 14,970 19,479 185,165 10,634
MS 57,260 18,657 18,095 74,183 13,845 27,660 20,460 27,166 42,490 18,584 152,150 27,204
Clubfoot 8,215 14,914 1,810 89,692 1,315 20,961 1,445 20,056 2,100 16,226 14,885 25,225
Craniosynostosis 960 30,115 3,035 47,606 1,485 34,028 680 36,084 205 19,316 6,365 39,658
Diaphragmatic hernia 1,040 110,848 915 195,456 390 22,978 155 40,803 755 23,732 3,255 100,562
Gastroschisis 1,325 85,080 505 186,873 155 18,598 150 14,763 200 12,744 2,335 91,969
Limb deficiencies
or reduction defects
1,125 21,628 350 70,995 495 31,571 655 26,979 790 18,491 3,415 28,430
Omphalocele 980 48,074 460 158,502 335 40,173 75 32,640 105 10,330 1,955 70,084
Other syndrome affecting
multiple systems
1,725 66,503 3,555 92,066 4,560 31,502 5,065 28,560 14,145 21,905 29,050 35,806
Other defect 9,645 107,240 8,035 138,524 7,165 34,298 6,310 23,981 11,720 18,173 42,875 64,313

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.

Return to your place in the textFIGURE. Weighted estimates of median costs of hospitalizations, by birth defect*,† and age group at admission — National Inpatient Sample, United States, 2019

Abbreviation: USD = U.S. dollars.

* Identified by scanning up to 40 available fields of International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. Critical cardiovascular defects include common arterial trunk (Q20.0), double outlet right ventricle (Q20.1), transposition of the great arteries (Q20.3), single ventricle (Q20.4), tetralogy of Fallot (Q21.3), pulmonary valve atresia (Q22.0), tricuspid valve atresia (Q22.4), Ebstein anomaly (Q22.5), hypoplastic left heart syndrome (Q23.4), coarctation of aorta (Q25.1), interrupted aortic arch (Q25.21), and total anomalous pulmonary venous connection (Q26.2). Specific birth defects are identified as gastroschisis (Q79.3), small intestinal atresia or stenosis (Q41), diaphragmatic hernia (Q79.0 and Q79.1), spina bifida without anencephaly (Q05, Q07.01, and Q07.03), and trisomy 21 (Q90).

The specific birth defects shown were selected to represent a range of body systems.


Suggested citation for this article: Swanson J, Ailes EC, Cragan JD, et al. Inpatient Hospitalization Costs Associated with Birth Defects Among Persons Aged <65 Years — United States, 2019. MMWR Morb Mortal Wkly Rep 2023;72:739–745. DOI: http://dx.doi.org/10.15585/mmwr.mm7227a1.

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