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Zhang Y, Delahanty MT, Engel SM, Marshall S, O’Shea TM, Garcia T, Schieve LA, Bradley C, Daniels JL. Malpresentation and autism spectrum disorder in the study to explore early development. Paediatr Perinat Epidemiol 2024; 38:397-407. [PMID: 39031568 PMCID: PMC11321235 DOI: 10.1111/ppe.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND An infant's presentation at delivery may be an early indicator of developmental differences. Non-vertex presentation (malpresentation) complicates delivery and often leads to caesarean section, which has been associated with neurodevelopmental delays, including autism spectrum disorder (ASD). However, malpresentation could be an early sign of an existing developmental problem that is also an upstream factor from caesarean delivery. Little research has been done to investigate the association between malpresentation and ASD. OBJECTIVES We examine the association between malpresentation at delivery and ASD and whether this association differs by gestational age. METHODS We used data from the Study to Explore Early Development (SEED), a multi-site, case-control study of children with ASD compared to population controls. The foetal presentation was determined using medical records, birth records and maternal interviews. We defined malpresentation as a non-vertex presentation at delivery, then further categorised into breech and other malpresentation. We used multivariable logistic regression to estimate the adjusted odds ratio (aOR) for the association between malpresentation and ASD. RESULTS We included 4047 SEED participants, 1873 children with ASD and 2174 controls. At delivery, most infants presented vertex (n = 3760, 92.9%). Malpresentation was associated with higher odds of ASD (aOR 1.31, 95% confidence interval [CI] 1.02, 1.68) after adjustment for maternal age, poverty level, hypertensive disorder and smoking. The association was similar for breech and other types of malpresentation (aOR 1.28, 95% CI 0.97, 1.70 and aOR 1.40, 95% CI 0.87, 2.26, respectively) and did not differ markedly by gestational age. CONCLUSIONS Malpresentation at delivery was modestly associated with ASD. Early monitoring of the neurodevelopment of children born with malpresentation could identify children with ASD sooner and enhance opportunities to provide support to optimise developmental outcomes.
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Affiliation(s)
- Yitian Zhang
- Epidemiology and Database Studies, Real World Solutions, IQVIA Inc, Durham, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Michelle T. Delahanty
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stephanie M. Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stephen Marshall
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - T. Michael O’Shea
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Tanya Garcia
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Laura A. Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chyrise Bradley
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Julie L. Daniels
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Zhang Y, Heelan-Fancher L, Leveille S, Shi L. Health Disparities in the Use of Primary Cesarean Delivery among Asian American Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6860. [PMID: 37835130 PMCID: PMC10572660 DOI: 10.3390/ijerph20196860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
This study examined the health disparities in primary cesarean delivery (PCD) use among Asian American (AA) women and within AA subgroups. We examined 22 years of birth registry data from one diverse northeastern state in the United States, including singleton vertex live births between 24 and 44 weeks of gestation without congenital abnormalities. Multivariate logistic regression was used to test the association between PCD and race and ethnicity groups adjusting for maternal demographic and health behaviors, infant gender and birth weight, gestational age, initiation of prenatal care, and other risk factors. Among the eligible sample, 8.3% were AA. AAs had the highest rate of PCD (18%) among all racial and ethnic groups. However, extensive heterogeneity was found among the AA subgroups. After controlling for confounding variables, compared to non-Hispanic White women, Filipino, Asian Indian, and Other Asian subgroups had a higher risk for PCD (Adj OR = 1.40, 1.37, and 1.21, p < 0.001), while Japanese, Chinese, and Korean had a lower risk (Adj OR = 0.57, 0.83, and 0.90, p < 0.001), and Vietnamese had no significant difference in PCD use. Although AA as a single racial and ethnic group had higher prevalence of PCD, more studies are warrantied to address the disproportional distribution of health disparities in PCD use within AA subgroups.
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Affiliation(s)
- Yuqing Zhang
- College of Nursing, University of Cincinnati, Cincinnati, OH 45040, USA
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
| | - Lisa Heelan-Fancher
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
| | - Suzanne Leveille
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
| | - Ling Shi
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
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McCarthy KJ, Liu SH, Huynh M, Kennedy J, Chan HT, Mayer VL, Vieira L, Tabaei B, Howell F, Lee A, Van Wye G, Howell EA, Janevic T. Influence of Gestational Diabetes Mellitus on Diabetes Risk and Glycemic Control in a Retrospective Population-Based Cohort. Diabetes Care 2023; 46:1483-1491. [PMID: 37341505 PMCID: PMC10369124 DOI: 10.2337/dc22-1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 05/05/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Racial/ethnic-specific estimates of the influence of gestational diabetes mellitus (GDM) on type 2 diabetes remain underexplored in large population-based cohorts. We estimated racial/ethnic differences in the influence of GDM on diabetes risk and glycemic control in a multiethnic, population-based cohort of postpartum women. RESEARCH DESIGN AND METHODS Hospital discharge and vital registry data for New York City (NYC) births between 2009 and 2011 were linked with NYC A1C Registry data between 2009 and 2017. Women with baseline diabetes (n = 2,810) were excluded for a final birth cohort of 336,276. GDM on time to diabetes onset (two A1C tests of ≥6.5% from 12 weeks postpartum onward) or glucose control (first test of A1C <7.0% following diagnosis) was assessed using Cox regression with a time-varying exposure. Models were adjusted for sociodemographic and clinical factors and stratified by race/ethnicity. RESULTS The cumulative incidence for diabetes was 11.8% and 0.6% among women with and without GDM, respectively. The adjusted hazard ratio (aHR) of GDM status on diabetes risk was 11.5 (95% CI 10.8, 12.3) overall, with slight differences by race/ethnicity. GDM was associated with a lower likelihood of glycemic control (aHR 0.85; 95% CI 0.79, 0.92), with the largest negative influence among Black (aHR 0.77; 95% CI 0.68, 0.88) and Hispanic (aHR 0.84; 95% CI 0.74, 0.95) women. Adjustment for screening bias and loss to follow-up modestly attenuated racial/ethnic differences in diabetes risk but had little influence on glycemic control. CONCLUSIONS Understanding racial/ethnic differences in the influence of GDM on diabetes progression is critical to disrupt life course cardiometabolic disparities.
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Affiliation(s)
- Katharine J. McCarthy
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Blavatnik Family Women’s Health Research Institute, New York, NY
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shelley H. Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mary Huynh
- Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY
| | - Joseph Kennedy
- Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY
| | - Hiu Tai Chan
- Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY
| | - Victoria L. Mayer
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Luciana Vieira
- Blavatnik Family Women’s Health Research Institute, New York, NY
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Maternal and Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bahman Tabaei
- Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY
| | - Frances Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Blavatnik Family Women’s Health Research Institute, New York, NY
| | - Alison Lee
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gretchen Van Wye
- Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY
| | - Elizabeth A. Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Teresa Janevic
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Blavatnik Family Women’s Health Research Institute, New York, NY
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
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Brazier E, Borrell LN, Huynh M, Kelly EA, Nash D. Impact of new labor management guidelines on Cesarean rates among low-risk births at New York City hospitals: A controlled interrupted time series analysis. Ann Epidemiol 2023; 79:3-9. [PMID: 36621618 DOI: 10.1016/j.annepidem.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/16/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023]
Abstract
PURPOSE To examine the impact of the American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine (ACOG-SMFM) 2014 recommendations for preventing unnecessary primary Cesareans. METHODS In a population-based cohort of births in New York City from 2012 to 2016, we used controlled interrupted time series analyses to estimate changes in age-standardized Cesarean rates among nulliparous, term, singleton vertex (NTSV) deliveries. RESULTS Among 192,405 NTSV births across 40 hospitals, the age-standardized NTSV Cesarean rate decreased after the ACOG-SMFM recommendations from 25.8% to 24.0% (Risk ratio [RR]: 0.93; 95% CI 0.89, 0.97), with no change in the control series. Decreases were observed among non-Hispanic White women (RR: 0.89; 95% CI 0.82, 0.97), but not among non-Hispanic Black women (RR: 0.97; 95% CI 0.88, 1.07), Asian/Pacific Islanders (RR: 1.01; 95% CI 0.91, 1.12), or Hispanic women (RR: 0.94; 95% CI 0.86, 1.02). Similar patterns were observed at teaching hospitals, with no change at nonteaching hospitals. CONCLUSIONS While low-risk Cesarean rates may be modifiable through changes in labor management, additional research, and interventions to address Cesarean disparities, are needed.
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Affiliation(s)
- Ellen Brazier
- CUNY Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York, New York, NY; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY.
| | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY
| | - Mary Huynh
- Office of Vital Statistics, Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY
| | - Elizabeth A Kelly
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH
| | - Denis Nash
- CUNY Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York, New York, NY; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY
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Ayala NK, Schlichting L, Lewkowitz AK, Kole-White MB, Gjelsvik A, Monteiro K, Amanullah S. The Association of Antenatal Depression and Cesarean Delivery among First-Time Parturients: A Population-Based Study. Am J Perinatol 2023; 40:356-362. [PMID: 36228650 PMCID: PMC9970759 DOI: 10.1055/a-1960-2919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Antenatal depression (AD) has been considered a risk factor for cesarean delivery (CD); however, the supporting data are inconsistent. We used a large, nationally representative dataset to evaluate whether there is an association between AD and CD among women delivering for the first time. STUDY DESIGN We utilized the 2016 to 2019 Multistate Pregnancy Risk Assessment Monitoring System (PRAMS) from the Centers for Disease Control. First-time parturients who reported depression in the 3 months prior to or at any point during their recent pregnancy were compared with those who did not. The mode of delivery was obtained through the birth certificate. Maternal demographics, pregnancy characteristics, and delivery characteristics were compared by the report of AD using bivariable analyses. Population-weighted multivariable regression was performed, adjusting for maternal age, race/ethnicity, insurance, pregnancy complications, preterm birth, and body mass index (BMI). RESULTS Of the 61,605 people who met the inclusion criteria, 18.3% (n = 11,896) reported AD and 29.8% (n = 19,892) underwent CD. Parturients with AD were younger, more likely to be non-Hispanic white, publicly insured, use tobacco in pregnancy, deliver earlier, have lower levels of education, higher BMIs, and more medical comorbidities (hypertension and diabetes). After adjustment for these differences, there was no difference in risk of CD between those with AD compared with those without (adjusted odds ratio: 1.04; 95% confidence interval: 0.97-1.13). CONCLUSION In a large, population-weighted, nationally representative sample of first-time parturients, there was no association between AD and CD. KEY POINTS · Antenatal depression is increasingly common and has multiple known morbidities.. · Prior data on antenatal depression and cesarean delivery are mixed.. · We found no association between depression and cesarean delivery..
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Affiliation(s)
- Nina K. Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
- Address for correspondence Nina K. Ayala, MD Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island101 Dudley Street, Providence, RI 02905
| | - Lauren Schlichting
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
| | - Adam K. Lewkowitz
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Martha B. Kole-White
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Annie Gjelsvik
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Siraj Amanullah
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Health Services, Policy and Practice, Brown School of Public Health, Providence, Rhode Island
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Brazier E, Borrell LN, Huynh M, Kelly EA, Nash D. Variation and racial/ethnic disparities in Caesarean delivery at New York City hospitals: The contribution of hospital-level factors. Ann Epidemiol 2022; 73:1-8. [PMID: 35728734 DOI: 10.1016/j.annepidem.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE We aimed to quantify general and specific contextual effects associated with Caesarean delivery at New York City (NYC) hospitals, overall and by maternal race/ethnicity. METHODS Among 127,449 singleton, nulliparous births at NYC hospitals from 2015 to 2017, we used multilevel logistic regression to examine the association of hospital characteristics (public/private ownership, teaching status and delivery caseloads) with Caesarean delivery, overall, and by maternal race/ethnicity. We estimated the intra-class correlation (ICC) to examine general contextual effects and 80% interval odds ratios (IOR) and percentage of opposed odds ratios (POOR) to examine specific contextual effects. RESULTS Overall, 27.8% of births were Caesareans. The general contextual (hospital) effect on Caesarean delivery was small (ICC: 1.8%). Hospital characteristics associated with Caesarean delivery differed by maternal race/ethnicity, with delivery in teaching hospitals reducing the odds of Caesarean delivery among White (IOR: 0.31, 0.86; POOR: 4.7%) and Asian women (IOR: 0.41, 0.95; POOR: 7.3%), but not among Black (IOR: 0.51, 1.34; POOR: 30.7%) or Hispanic women (IOR: 0.44, 1.24; POOR: 22.6%). Hospital ownership and caseloads were not associated with Caesarean delivery for any group. CONCLUSION There is little within-hospital clustering of Caesarean delivery, suggesting that Caesarean disparities may not be explained by hospital of delivery.
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Affiliation(s)
- Ellen Brazier
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY; Department of Epidemiology & Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY.
| | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY
| | - Mary Huynh
- Office of Vital Statistics, Bureau of Vital Statistics, NYC Department of Health and Mental Hygiene, New York, NY
| | - Elizabeth A Kelly
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY; Department of Epidemiology & Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY
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Lê-Scherban F, Moore J, Headen I, Utidjian L, Zhao Y, Forrest CB. Are there birth cohort effects in disparities in child obesity by maternal education? Int J Obes (Lond) 2020; 45:599-608. [PMID: 33335294 DOI: 10.1038/s41366-020-00724-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children belonging to the same birth cohort (i.e., born in the same year) experience shared exposure to a common obesity-related milieu during the critical early years of development-e.g., secular beliefs and feeding practices, adverse chemical exposures, food access and nutrition assistance policies-that set the stage for a shared trajectory of obesity as they mature. Fundamental cause theory suggests that inequitable distribution of recent efforts to stem the rise in child obesity may exacerbate cohort-based disparities over time. METHODS Data were from electronic health records spanning 2007-2016 linked to birth records for children ages 2-19 years. We used hierarchical age-period-cohort models to investigate cohort effects on disparities in obesity related to maternal education. We hypothesized that maternal education-based disparities in prevalence of obesity would be larger among more recent birth cohorts. RESULTS Sex-stratified models adjusted for race/ethnicity showed substantial obesity disparities by maternal education that were evident even at young ages: prevalence among children with maternal education < high school compared to maternal college degree was approximately three times as high among girls and twice as high among boys. For maternal education < high school, disparities compared to maternal college degree were higher in more recent birth cohorts. Among girls, this disparity cohort effect was evident at younger ages (at age 4, the disparity increased by 4 [0.1-8] percentage points per 5 birth years), while among boys it was larger at older ages (at age 16, the disparity increased by 7 [1-14] percentage points per 5 birth years). CONCLUSIONS There may be widening maternal education-based disparities in child obesity by birth cohort at some ages.
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Affiliation(s)
- Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, 5th Floor, Philadelphia, PA, 19104, USA. .,Drexel Urban Health Collaborative, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, 19104, USA.
| | - Jeffrey Moore
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, 5th Floor, Philadelphia, PA, 19104, USA
| | - Irene Headen
- Drexel Urban Health Collaborative, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, 19104, USA.,Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, 4th Floor, Philadelphia, PA, 19104, USA
| | - Levon Utidjian
- Division of General Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Applied Clinical Research Center, Department of Pediatrics, Children's Hospital of Philadelphia, 2716 South Street, Suite 11-473, Philadelphia, PA, 19104, USA
| | - Yuzhe Zhao
- Drexel Urban Health Collaborative, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, 19104, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, Department of Pediatrics, Children's Hospital of Philadelphia, 2716 South Street, Suite 11-473, Philadelphia, PA, 19104, USA
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Haidari ES, Lee HC, Illuzzi JL, Lin H, Xu X. Utility of Birth Certificate Data for Evaluating Hospital Variation in Admissions to NICUs. Hosp Pediatr 2020; 10:190-194. [PMID: 32005648 DOI: 10.1542/hpeds.2019-0116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Efforts to study potential overuse of NICU admissions and hospital variation in practice are often hindered by a lack of an appropriate data source. We examined the concordance of hospital-level NICU admission rates between birth certificate data and California Children's Services (CCS) data to inform the utility of birth certificate data in studying hospital variation in NICU admissions. METHODS We analyzed birth certificate data from California in 2012 and hospital-specific summary data from CCS regarding NICU admissions. NICU admission rates were calculated for both data sets while using CCS data as the gold standard. The difference between birth certificate-based and CCS-based NICU admission rates was assessed by using the Wilcoxon signed rank test, and concordance between the 2 rates was evaluated by using Lin's concordance correlation coefficient and Kendall's W concordance coefficient. RESULTS Among a total of 103 hospitals that were linked between the 2 data sets, birth certificate data generally underreported NICU admission rates compared with CCS data (median = 7.72% vs 11.51%; P < .001). However, in a subset of 35 hospitals where the difference in NICU admission rates between the 2 data sets was small, the birth certificate-based NICU admission rate showed good concordance with the rate from CCS data (Lin's concordance correlation coefficient = 0.91; 95% confidence interval: 0.84-0.95; Kendall's W concordance coefficient = 0.99; P < .001). Hospitals with good-concordance data did not differ from other hospitals in the institutional characteristics assessed. CONCLUSIONS For a selected subset of hospitals, birth certificate data may offer a reasonable means to investigate hospital variation in NICU admissions.
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Affiliation(s)
- Eman S Haidari
- Neonatal-Perinatal Medicine Fellowship Program, Maternal and Child Health Research Institute, and
- Department of Pediatrics, Stanford Medicine, Stanford University, Stanford, California; and
| | - Henry C Lee
- Department of Pediatrics, Stanford Medicine, Stanford University, Stanford, California; and
| | - Jessica L Illuzzi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine and
| | - Haiqun Lin
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut
| | - Xiao Xu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine and
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