Congenital malformations-related mortality trends in under-five U.S. children: A 24-year analysis from CDC-WONDER database (1999-2023).

BackgroundCongenital malformations remain a major cause of under-five mortality in the United States, yet contemporary long-term trends and demographic disparities have not been comprehensively evaluated. This study examined national patterns in congenital malformation-related mortality among U.S. children under 5 years from 1999 to 2023.MethodsMortality data were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) Database, focusing on congenital malformations-related deaths among children aged under 5 years between 1999 and 2023 in the U.S. Cases were identified using ICD-10 codes from Q00 to Q89.9.ResultsThis comprehensive analysis included a total of 143,931 deaths, demonstrating significant trends and disparities. The overall age-adjusted mortality rate (AAMR) declined from 34.70 (95% CI: 33.86-35.54) in 1999 to 25.95 (95% CI: 25.21-26.68) in 2023, showing an average annual percentage change (AAPC) of -1.21 (95% CI: -1.50 to -1.02). Mortality was higher in males than in females. Across all races, the least decline was noted among NH American Indian or Alaska Natives. Non-metropolitan areas exhibited higher overall AAMR (34.80 [95% CI: 34.33-35.27]) compared to metropolitan areas (29.02 [95% CI: 28.85-29.19]).ConclusionThe overall AAMR decreased from 1999 to 2023, with significantly higher deaths among males, rural regions and Alaskan Natives. These findings demonstrate an overall decline in mortality but persistent demographic and geographic inequities, highlighting the need for targeted public health and policy interventions to improve outcomes for vulnerable pediatric populations.