Birth Defects Cost $22.2 Billion in U.S. Hospital Stays in 2019

Major structural birth defects — from genetic, chromosomal, teratogenic or unknown causes — affect about 3% of U.S. live births and are the leading cause of infant death, responsible for 21% of newborn and infant deaths. Treating them costs money throughout a person's life, and as treatments and prices change, cost estimates need updating.

Researchers from CDC and the University of South Florida used the 2019 National Inpatient Sample, the largest publicly available all-payer hospital database in the country, to estimate the cost of hospital stays among people under 65 with one or more birth defects listed among their diagnoses.

Key findings

• There were 937,295 birth defect–associated hospitalizations, costing an estimated $22.2 billion.
• They made up 4.1% of all hospitalizations of people under 65, but 7.7% of the costs.
• Nearly half of the costs came in the first year of life.
• Heart and blood vessel (cardiovascular) defects were the most common category (22.3% of stays) and cost $9.8 billion — 44.3% of the total.

By age

Among first-year stays, 15.3% also carried a preterm birth code, and those accounted for 45.9% of first-year costs.

By type of defect

A stay with several defects counts under each, so shares sum to more than 100%.

Critical heart defects had the highest median cost per stay, $29,430. For infants after their birth stay, the defects with mean costs above $150,000 included:

Median cost per hospitalization for selected birth defects, by age group, 2019. From CDC's MMWR.

About 52.2% of the stays were paid by Medicare or Medicaid and 40.2% by private insurance.

Compared with 2013

An earlier estimate from 2013 data put the cost at $19.1 billion for people under 65 — but it included professional fees, which historically add 20%–25% to facility costs. With the same adjustment, the 2019 figure would be $26.6–27.8 billion. In 2019 prices, the 2013 estimate equals $21.0 billion. Across all ages, birth defects' share of hospital spending was similar: 5.2% in 2013 and 5.5% in 2019.

How it was measured

The sample covers 20% of discharges from short-term, nonfederal community hospitals and counts stays, not patients. People 65 and older were left out to limit miscoding of age-related conditions (especially heart problems) as birth defects. Defects were identified from up to 40 diagnosis codes per stay; some heart findings common in newborns or preterm babies, and 23 minor conditions, were not counted. Costs were estimated by applying each hospital's cost-to-charge ratio to its bill.

Limits: it's hard to know which costs are caused by a birth defect; stays with several defects inflate per-defect totals; hospital-wide cost ratios may not fit particular services; physician fees aren't included, so costs are underestimated; and costs for preterm babies may partly reflect prematurity rather than the defect.

Why it matters

Updated estimates show how much health care people with birth defects use across their lives, and point to the need to keep understanding their ongoing health care needs.

Sources

Based on Swanson J, Ailes EC, Cragan JD, et al., "Inpatient Hospitalization Costs Associated with Birth Defects Among Persons Aged <65 Years — United States, 2019," Morbidity and Mortality Weekly Report 72(27), CDC; a work of the United States government in the public domain.