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What the experts said
A systematic review by the study group demonstrated that the incidence of CDH varies significantly between regions and populations with a global overall incidence of 2.3 per 10,000 births.
There are no national Canadian epidemiological studies examining CDH prior to this study.
The study utilized the Canadian Institute of Health Information discharge abstract database from 2006 to 2020 and Quebec's Med Echo database from 2008 to 2020.
CDH cases were identified using the validated ICD-10 code Q79.0.
The CIHI database included both live and stillbirths, whereas the Med Echo database only included live births.
Terminations were excluded from both databases.
There was no distinction between isolated versus complex CDH nor laterality in the databases.
The Canadian incidence of CDH from 2006 to 2020 was 2.71 per 10,000 births.
Manitoba had the highest incidence of CDH, followed by Nova Scotia and Saskatchewan.
Manitoba had a significantly higher incidence of CDH compared to Ontario with an incidence rate ratio of 1.33.
58% of CDH patients were assigned male sex at birth.
There was no significant difference in CDH incidence over time from 2006 to 2020.
Advanced maternal age, specifically maternal age 40 plus, was associated with an increased rate of CDH with an incidence rate ratio of 1.68.
The study was limited by use of aggregate versus patient level data, preventing control for various covariates and determination of independence of associations.
Administrative data is limited in terms of what is collected and is subject to misclassification and imputation errors.
This represents the first national study examining CDH incidence in Canada.
Similar to other populations, male fetal sex and older maternal age are associated with an increased incidence of CDH.
In Manitoba, there is not an overall increased maternal age according to Statistics Canada trends.
The study group hypothesizes that there is an interplay between genetic, environmental, and sociodemographic influences affecting CDH incidence in Manitoba.
A paper by Lou et al. found an increased incidence of gastroschisis in Manitoba, with northern regions of the province showing higher incidence.
The elevated gastroschisis incidence in northern Manitoba is thought to be related to the communities that settle in northern regions, access to prenatal care, and prenatal exposures.