Objective: The purpose of this study was to assess the effect of maternal age on the rate of stillbirth in a large, nationwide sample of deliveries in the United States. Study design: Data were derived from the Nation...Objective: The purpose of this study was to assess the effect of maternal age on the rate of stillbirth in a large, nationwide sample of deliveries in the United States. Study design: Data were derived from the Nationwide Inpatient Sample for the years 1995 through 2002. With the use of ICD- 9 codes, the rate of stillbirth was determined as a function of maternal age. Multivariate regression analysis was used to assess the effect of maternal age on the odds of stillbirth, with adjustment for multiple known risk factors for stillbirth. Results: There were 5,874,203 deliveries that were identified for analysis. The unadjusted rate of stillbirth was elevated for teenagers and for women aged ≥ 35 years. In the multivariate analysis, compared with women 20 to 34 years old, women who were ≤ 19 years old were more likely to have a pregnancy outcome of stillbirth (odds ratio, 1.11; 95% CI, 1.08- 1.14), as were women who were 35 to 39 years old (odds ratio, 1.28; 95% CI, 1.24- 1.32) and women who were ≥ 40 years old (odds ratio, 1.72; 95% CI, 1.63- 1.81). Conclusion: The extremes of maternal age are associated with an increased risk for stillbirth, even after adjustment for a large number of known predisposing conditions.展开更多
Objective:To estimate the potential savings,both in terms of costs and lengt hs of stay,of one-week increases in gestational age for premature infants.The purpose is to provide population-based data that can be used t...Objective:To estimate the potential savings,both in terms of costs and lengt hs of stay,of one-week increases in gestational age for premature infants.The purpose is to provide population-based data that can be used to assess the pot ential savings of interventions that delay premature delivery.Data:Cohort data for all births in California in 1998-2000 that linked vital records data with those from hospital discharge abstracts,including those of neonatal transport.All infants with a gestational age between 24 and 37 weeks were included.There were 193,167 infants in the sample after deleting cases with incomplete data or gestational age that was inconsistent with birth weight.Methods:Hospital costs were estimated by adjusting charges by hospital-specific costs-to-charges ra tios.Data were aggregated across transport into episodes of care.Mean and medi an potential savings were calculated for increasing gestational age,in one-wee k intervals.The 25th and 75th percentiles were used to estimate ranges.Results :The results are presented in matrix format,for starting gestational ages of 24-34 weeks,with ending gestational ages of 25 to 37 weeks.Costs and lengths of stay decreased with gestational age from a med ian of ＄216,814(92 days)at 24 weeks to ＄591(2 days)at 37 weeks.The potent ial savings from delaying premature labor are quite large;the median savings fo r a 2 week increase in gestational age were between ＄28,870 and ＄64,021 for ge stational ages below 33 weeks,with larger savings for longer delays in delivery.Delaying deliveries < 29 weeks to term(37 weeks)resulted in savings of over ＄122,000 per case,with the savings being over ＄206,000 for deliveries < 26 we eks.Conclusions:These results provide population-based data that can be appli ed to clinical trials data to assess the impacts on costs and lengths of stay of interventions that delay premature labor.They show that the potential savings of delaying premature labor are quite large,especially for extremely premature deliveries.展开更多
文摘Objective: The purpose of this study was to assess the effect of maternal age on the rate of stillbirth in a large, nationwide sample of deliveries in the United States. Study design: Data were derived from the Nationwide Inpatient Sample for the years 1995 through 2002. With the use of ICD- 9 codes, the rate of stillbirth was determined as a function of maternal age. Multivariate regression analysis was used to assess the effect of maternal age on the odds of stillbirth, with adjustment for multiple known risk factors for stillbirth. Results: There were 5,874,203 deliveries that were identified for analysis. The unadjusted rate of stillbirth was elevated for teenagers and for women aged ≥ 35 years. In the multivariate analysis, compared with women 20 to 34 years old, women who were ≤ 19 years old were more likely to have a pregnancy outcome of stillbirth (odds ratio, 1.11; 95% CI, 1.08- 1.14), as were women who were 35 to 39 years old (odds ratio, 1.28; 95% CI, 1.24- 1.32) and women who were ≥ 40 years old (odds ratio, 1.72; 95% CI, 1.63- 1.81). Conclusion: The extremes of maternal age are associated with an increased risk for stillbirth, even after adjustment for a large number of known predisposing conditions.
文摘Objective:To estimate the potential savings,both in terms of costs and lengt hs of stay,of one-week increases in gestational age for premature infants.The purpose is to provide population-based data that can be used to assess the pot ential savings of interventions that delay premature delivery.Data:Cohort data for all births in California in 1998-2000 that linked vital records data with those from hospital discharge abstracts,including those of neonatal transport.All infants with a gestational age between 24 and 37 weeks were included.There were 193,167 infants in the sample after deleting cases with incomplete data or gestational age that was inconsistent with birth weight.Methods:Hospital costs were estimated by adjusting charges by hospital-specific costs-to-charges ra tios.Data were aggregated across transport into episodes of care.Mean and medi an potential savings were calculated for increasing gestational age,in one-wee k intervals.The 25th and 75th percentiles were used to estimate ranges.Results :The results are presented in matrix format,for starting gestational ages of 24-34 weeks,with ending gestational ages of 25 to 37 weeks.Costs and lengths of stay decreased with gestational age from a med ian of ＄216,814(92 days)at 24 weeks to ＄591(2 days)at 37 weeks.The potent ial savings from delaying premature labor are quite large;the median savings fo r a 2 week increase in gestational age were between ＄28,870 and ＄64,021 for ge stational ages below 33 weeks,with larger savings for longer delays in delivery.Delaying deliveries < 29 weeks to term(37 weeks)resulted in savings of over ＄122,000 per case,with the savings being over ＄206,000 for deliveries < 26 we eks.Conclusions:These results provide population-based data that can be appli ed to clinical trials data to assess the impacts on costs and lengths of stay of interventions that delay premature labor.They show that the potential savings of delaying premature labor are quite large,especially for extremely premature deliveries.
