{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:00:16Z","timestamp":1792789216484,"version":"4.5.0"},"reference-count":14,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"SNUH Lee Kun-hee Child Cancer & Rare Disease Project","award":["25C-042-0100"],"award-info":[{"award-number":["25C-042-0100"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Congenital diaphragmatic hernia (CDH) is a rare but serious congenital anomaly linked to high mortality rates and significant long-term morbidity. Although numerous prognostic factors for short-term outcomes have been identified through hospital-based studies, data on long-term mortality at the population level are limited. Specifically, nationwide assessments of long-term outcomes for infants with CDH are scarce. This study aimed to estimate the national 5-year all-cause mortality for CDH and to create a population-level risk stratification nomogram utilizing nationwide health insurance claims data. Methods: We conducted a retrospective cohort study of infants with CDH using nationwide insurance claims data from 2002 to 2016, allowing for complete 5-year follow-up. We analyzed population-level demographic and clinical proxy variables with Cox proportional hazards models and developed a nomogram for long-term mortality risk stratification. Results: Factors such as rural residence, middle-to-high SES, respiratory distress in newborns, and CHD were associated with increased 5-year mortality in infants with CDH. The claims-based nomogram, which incorporated sociodemographic and comorbidity variables, demonstrated moderate discriminatory power (AUC 0.76; C-index 0.78) for population-level risk stratification. Conclusions: This nationwide claims-based cohort study provides population-level estimates of 5-year mortality associated with CDH and introduces a nomogram that offers moderate discriminatory ability for long-term risk stratification.<\/jats:p>","DOI":"10.3390\/children13010108","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T12:44:44Z","timestamp":1768221884000},"page":"108","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk Stratification of Long-Term Mortality in Infants with Congenital Diaphragmatic Hernia Using the National Health Insurance Service (NHIS) Data"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9103-8631","authenticated-orcid":false,"given":"Hye Ji","family":"Han","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Ji","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0294-7190","authenticated-orcid":false,"given":"In Young","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Soo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwan Soo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7287-4300","authenticated-orcid":false,"given":"Hyeon-Jong","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University College of Medicine, Seoul 04401, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7817-8728","authenticated-orcid":false,"given":"Dong In","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0707-6839","authenticated-orcid":false,"given":"Kyung Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"},{"name":"Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1038\/s41572-022-00362-w","article-title":"Congenital diaphragmatic hernia","volume":"8","author":"Zani","year":"2022","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1183\/09031936.00066511","article-title":"Congenital diaphragmatic hernia","volume":"39","author":"Kotecha","year":"2012","journal-title":"Eur. Respir. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40748-017-0045-1","article-title":"Congenital diaphragmatic hernia\u2014A review","volume":"3","author":"Chandrasekharan","year":"2017","journal-title":"Matern. Health Neonatol. Perinatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"58","DOI":"10.5468\/ogs.2016.59.1.58","article-title":"Impaction of an intrathoracic kidney acted as a shield against herniation of the abdominal viscera in a case of right congenital diaphragmatic hernia","volume":"59","author":"Jeong","year":"2016","journal-title":"Obstet. Gynecol. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1159\/000497619","article-title":"Maternal risk factors and perinatal characteristics in congenital diaphragmatic hernia: A nationwide population-based study","volume":"46","author":"Ehren","year":"2019","journal-title":"Fetal Diagn. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.annepidem.2020.11.007","article-title":"Prevalence and mortality in children with congenital diaphragmatic hernia: A multicountry study","volume":"56","author":"Politis","year":"2021","journal-title":"Ann. Epidemiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1097\/SLA.0000000000005113","article-title":"Mortality in congenital diaphragmatic hernia: A multicenter registry study of over 5000 patients over 25 years","volume":"277","author":"Gupta","year":"2023","journal-title":"Ann. 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Perinatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100217","DOI":"10.1016\/j.clinsp.2023.100217","article-title":"Post-natal prognostic factors in CDH: Experience of 11 years in a referral center in Brazil","volume":"78","author":"Nam","year":"2023","journal-title":"Clinics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.2353\/ajpath.2006.060445","article-title":"Teratogen-induced, dietary and genetic models of congenital diaphragmatic hernia share a common mechanism of pathogenesis","volume":"169","author":"Clugston","year":"2006","journal-title":"Am. J. Pathol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/j.1753-4887.2009.00247.x","article-title":"Role of nutrition, lifestyle factors, and genes in the pathogenesis of congenital diaphragmatic hernia: Human and animal studies","volume":"67","author":"Beurskens","year":"2009","journal-title":"Nutr. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1002\/ajmg.a.30904","article-title":"Infants with Bochdalek diaphragmatic hernia: Sibling recurrence and monozygotic twin discordance in a hospital-based malformation surveillance program","volume":"138A","author":"Pober","year":"2005","journal-title":"Am. J. Med. Genet. A"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/108\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T13:26:36Z","timestamp":1768224396000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["children13010108"],"URL":"https:\/\/doi.org\/10.3390\/children13010108","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]}}}