What question did this study set out to answer?

This study aims to evaluate long-term trends and disparities in congenital malformation-related mortality among U.S. children under five from 1999 to 2023.

February 9, 2026

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

Key Points

This study aims to evaluate long-term trends and disparities in congenital malformation-related mortality among U.S. children under five from 1999 to 2023.
Obtained mortality data from the CDC-WONDER database.
Focused on deaths related to congenital malformations in children under five.
Identified cases using ICD-10 codes from Q00 to Q89.9.
Overall age-adjusted mortality rate declined from 34.70 in 1999 to 25.95 in 2023.
Average annual percentage change was −1.21, indicating a decreasing trend.
Higher mortality rates observed in males compared to females.
The least decline in mortality was among NH American Indian or Alaska Natives.
Non-metropolitan areas reported higher mortality rates than metropolitan areas.

Abstract

Background Congenital 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. Methods Mortality 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. Results This 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). Conclusion The 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.

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