Abstract 15137: Association of Congenital Heart Defects With Childhood Cancer in Privately Insured US Children: A Rapid Claims Analysis
Background: As treatment for congenital heart defects (CHDs) has improved, understanding the long-term outcomes of survivors has become important. Recent studies have focused on the risk of adult-onset cancer in CHD survivors, but little is known about the incidence of childhood cancer in this population. Our objective was to determine the association of CHDs with childhood cancer using a nationwide administrative healthcare database of more than 100 million Americans.
Methods: Using the Treatment Pathways online analytic interface to access the Truven Health MarketScan® research databases, we examined the presence of ICD-9 diagnosis codes for neoplasm during 2009-2015 among 6.1 million children <18 years of age not coded for Down syndrome, continuously enrolled in employer-sponsored plans during 2014. To avoid overestimating the risk of cancer in CHD survivors, only those children with ≥1 CHD code during 2009-2014 ≥30 days prior to the first neoplasm code were considered to be CHD survivors with cancer. We calculated risk ratios and 95% confidence intervals using Taylor series variance approximation. Findings were confirmed with a sensitivity analysis limited to children with ≥2 outpatient CHD codes or ≥1 inpatient CHD code.
Results: There were 346 neoplasms identified among 88,493 children with CHDs (3.91/1000) and 4793 neoplasms among 6,040,429 children without CHDs (0.79/1000). Compared to those without CHDs, the risk ratio for the development of any neoplasm in those with CHDs was 4.9 (95% confidence interval [CI] 4.4-5.5) in the primary analysis and 6.4 (95% CI 5.7-7.2) in the sensitivity analysis. The risk was greatest for the development of bone tumors and neuroblastoma. (Figure)
Conclusions: Children with CHDs are at increased risk of developing neoplasms during childhood. Further investigations are needed to determine whether this association may be related to inherent factors (such as common biologic predisposition) or environmental factors.
Author Disclosures: M. Oster: None. A. Dawson: None. C. Wetmore: None. S. Grosse: None.
- © 2016 by American Heart Association, Inc.