Accounting for congenital malformations in North Carolina

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A SPECIAL REPORT SERIES BY THE N.C. DEPARTMENT OF t^UMAN RESOURCES, DIVISION OF
HEALTH SERVICES, STATE CENTER FOR HEALTH STATISTICS, P.O. BOX 2091, RALEIGH, N.C. 27602
April. 1»»4
ACCOUNTING FOR CONGENITAL MALFORMATIONS IN NORTH CAROLINA
by
Peggy D. Campbell
i
ABSTRACT
North Carolina death certificate data were utilized to provide a general description of mortality due to
congenital malformations. A similar examination of the incidence of malformations among North Carolina
births began with an assessment of the completeness of reporting malformations on birth certificates.
Birth certificate data for 1980 were compared with newborn records from the 1980 hospital discharge
data, it was found that North Carolina birth certificates reflected only about 20 percent of the congenital
anomalies cited on the hospital discharge records of newborns In 1980. This suggests a strong need for
developing a more complete system of reporting malformations among North Carolina's live births.
Introduction
Congenital malformations are a focus of concern in the
public health and medical communities due in part to their
ranking as a leading cause of infant mortality. Such anomal-ies
were listed as the underlying cause for the deaths of 335
North Carolinians in 1982. Over 70 percent of these were
persons under one year of age.
Beyond the mortality issue there are also ongoing medi-cal,
social, and economic implications associated with birth
defects in relation to childhood morbidity. These long-term
effects stem from the medical and physical handicaps
which frequently accompany serious anomalies.
For the purposes of the present study, a congenital mal-formation
is defined as "an abnormal condition that exists at
(or usually before) birth and results from a hereditary
defect, an environmental agent, or the interaction of
both." (5) This research has been confined to analysis of
codes 740-759 of the International Classification of Diseases
(9th revision) and excludes birth injuries and other compli-cations
of pregnancy.
The causes of congenital anomalies are of increasing
epidemiologic interest, especially with the introduction of
numerous new drugs and chemicals into the environment,
many of which may have teratogenic potential. Effective
research into the causes of birth defeas necessitates accu-rate
reporting of their occurrence. While a reasonably good
picture of deaths due to these causes can be obtained using
data supplied on death certificates, there is considerable
question as to whether official birth records provide an
adequate accounting of the incidence of malformations
among live births. (5,9)
It is this latter question which is a primary concern in this
paper. The purposes of this report are to describe the
reported incidence of congenital malformations among the
births and deaths of North Carolina residents, examine the
completeness of reporting anomalies on birth certificates,
and assess the usefulness of these data for monitoring and
epidemiologic research.