Pediatric demographics and regional trends from congenital anomalies of the kidney and urinary tract: A U.S. population-based study from 1999 to 2020

Congenital malformations of the urinary system contribute significantly to pediatric morbidity and mortality. Understanding national and subgroup-specific mortality trends can guide targeted healthcare interventions and policy responses. Mortality data for individuals aged 0 to 14 years from 1999 to 2020 were obtained from the CDC WONDER database. Deaths attributed to congenital anomalies of the urinary system were identified using the International Classification of Diseases, Tenth Revision (ICD-10) codes Q60-Q64. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, stratified by sex, race/ethnicity, geographic region, urban-rural classification, and state. Temporal trends in mortality were analyzed using Joinpoint regression models to estimate annual percentage changes and corresponding 95% confidence intervals. A total of 9412 deaths were recorded due to congenital anomalies of urinary system during the study period. The overall AAMR increased modestly from 0.61 in 1999 to 0.68 in 2020, representing an average annual percent change of + 0.62% (95% CI: -1.34 to 2.62) over the study period, with a significant decrease from 2007 to 2020 (APC: -1.36%; 95% CI: -2.01 to - 0.71). Males exhibited higher AAMRs than females (0.87 vs 0.49). Non-Hispanic Black (0.76) and Hispanic (0.70) children had AAMRs comparable to or higher than non-Hispanic Whites (0.70). The South region had the highest regional AAMR (0.79), and noncore rural areas showed the highest urbanization-specific AAMR (0.98). The District of Columbia recorded the highest state-level AAMR (1.35), while Massachusetts had the lowest (0.33). Despite an overall low and declining mortality rate, significant disparities persist across gender, race, geography, and urbanization. These findings highlight the need for equity-focused maternal-child health strategies to reduce preventable deaths from congenital urinary system anomalies.