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Rent S, Gaffur R, Nkini G, Sengoka EG, Mlay P, Moyer CA, Lemmon M, Docherty SL, Mmbaga BT, Staton CA, Shayo A. Perinatal loss in Tanzania: Perspectives of maternal-child healthcare providers. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003227. [PMID: 38768103 PMCID: PMC11104680 DOI: 10.1371/journal.pgph.0003227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/19/2024] [Indexed: 05/22/2024]
Abstract
Over 98% of stillbirths and neonatal deaths occur in Low- and Middle-Income Countries, such as Tanzania. Despite the profound burden of perinatal loss in these regions, access to facility or community-based palliative and psychosocial care is poor and understudied. In this study we explore perinatal loss through the lens of front-line healthcare providers, to better understand the knowledge and beliefs that guide their engagement with bereaved families. A Knowledge Attitudes and Practices survey addressing perinatal loss in Tanzania was developed, translated into Swahili, and administered over a 4-month period to healthcare professionals working at the Kilimanjaro Christian Medical Center (KCMC). Results were entered into REDCap and analyzed in R Studio. 74 providers completed the survey. Pediatric providers saw a yearly average of 5 stillbirths and 32.7 neonatal deaths. Obstetric providers saw an average of 11.5 stillbirths and 13.12 neonatal deaths. Most providers would provide resuscitation beginning at 28 weeks gestational age. Respondents estimated that a 50% chance of survival for a newborn occurred at 28 weeks both nationally and at KCMC. Most providers felt that stillbirth and neonatal mortality were not the mother's fault (78.4% and 81.1%). However, nearly half (44.6%) felt that stillbirth reflects negatively on the woman and 62.2% agreed that women are at higher risk of abuse or abandonment after stillbirth. A majority perceived that women wanted hold their child after stillbirth (63.0%) or neonatal death (70.3%). Overall, this study found that providers at KCMC perceived that women are at greater risk of psychosocial or physical harm following perinatal loss. How women can best be supported by both the health system and their community remains unclear. More research on perinatal loss and bereavement in LMICs is needed to inform patient-level and health-systems interventions addressing care gaps unique to resource-limited or non-western settings.
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Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Raziya Gaffur
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Getrude Nkini
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Enna Geofrey Sengoka
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Pendo Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Cheryl A. Moyer
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Monica Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America
- Department of Population Health Sciences, Duke University, Durham, North Carolina, United States of America
| | - Sharron L. Docherty
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Blandina T. Mmbaga
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Aisa Shayo
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Smith LK, van Blankenstein E, Fox G, Seaton SE, Martínez-Jiménez M, Petrou S, Battersby C. Effect of national guidance on survival for babies born at 22 weeks' gestation in England and Wales: population based cohort study. BMJ MEDICINE 2023; 2:e000579. [PMID: 38027415 PMCID: PMC10649719 DOI: 10.1136/bmjmed-2023-000579] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023]
Abstract
Objectives To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks' gestation in England and Wales. Design Population based cohort study. Setting England and Wales, comprising routine data for births and hospital records. Participants Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021. Main outcome measures Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21. Results For the 1001 babies alive at the onset of labour at 22 weeks' gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at <500g weight; 19% to 31% at 22 weeks+0 days to 22 weeks+3 days). Conclusions A change in national guidance to recommend a risk based approach was associated with a threefold increase in 22 weeks' gestation babies receiving survival focused care. The number of babies being admitted to neonatal units and those surviving to discharge increased.
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Affiliation(s)
- Lucy K Smith
- Population Health Sciences, University of Leicester, Leicester, UK
| | - Emily van Blankenstein
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Grenville Fox
- Neonatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sarah E Seaton
- Population Health Sciences, University of Leicester, Leicester, UK
| | - Mario Martínez-Jiménez
- Department of Economics and Public Policy, Centre for Health Economics & Policy Innovation, Imperial College Business School, London, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care and Health Science, Oxford University, Oxford, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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Rent S, Rocha T, Silva L, Souza JVP, Guinsburg R, Filho AC, Staton C, Vissoci JRN. The Impact of Time, Region, and Income Level on Stillbirth and Neonatal Mortality in Brazil, 2000-2019. J Pediatr 2023; 262:113613. [PMID: 37459908 DOI: 10.1016/j.jpeds.2023.113613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/06/2023] [Accepted: 07/11/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To describe trends in perinatal loss across Brazil, a country that transitioned in 2006 from a lower-middle income to an upper-middle income country, from 2000 to 2019 and analyze the effect of municipal wealth status on perinatal outcomes. STUDY DESIGN We conducted an ecological cohort study, based on publicly available data from the Brazilian Ministry of Health's data repository on live births and deaths. The Atlas of Human Development in Brazil was used to associate each region with a World Bank income classification. RESULTS The national neonatal mortality rate (NMR) for infants born at ≥22 weeks of gestation decreased from 21.2 in 2000 to 12.4 in 2019. The stillbirth rate (SBR) decreased from 12.0 to 10.2 during this period. For infants born between 22 and 27 weeks of gestation, worsening perinatal outcomes were seen after 2012. In 2019, the median rates of neonatal mortality and stillbirth were both 4 points higher in lower- to middle-income municipalities compared with high-income municipalities (P < .01). CONCLUSION Brazil has made significant progress in neonatal mortality and stillbirth from 2000 to 2019, yet inequity in perinatal outcomes remains and is correlated with municipal economic status. Nationally, ongoing improvement is needed for infants <28 weeks of gestation, and closer exploration is needed into why there are increasing rates of negative perinatal outcomes among infants born at 22-27 weeks of gestation after 2012.
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Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Global Health Institute, Durham, NC.
| | - Thiago Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC; Global Emergency Medicine Innovation and Implementation Center, Duke University, Durham, NC
| | - Lincoln Silva
- Global Emergency Medicine Innovation and Implementation Center, Duke University, Durham, NC
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Catherine Staton
- Duke Global Health Institute, Durham, NC; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Durham, NC; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC
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McClaskey B. Disparities in Neonatal Outcomes: Past, Present, and Our Future? Neonatal Netw 2023; 42:210-214. [PMID: 37491044 DOI: 10.1891/nn-2022-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 07/27/2023]
Abstract
Neonatal outcomes and infant mortality rates have improved significantly in the past century. However, the disparities in outcomes linked to racial and ethnic variations have persisted and actually increased. Those differences in outcomes have been acknowledged for years as care providers strive to improve care for all of our most vulnerable and youngest individuals. Trends in neonatal outcomes are summarized.
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Chi YC, Chu WM, Chang HY, Lu TH. International Variations in Dementia and Alzheimer Disease Diagnosis and Certification Habits and Their Associations With Dementia and Alzheimer Disease Mortality: A Cross-Sectional Study of 38 Countries. Alzheimer Dis Assoc Disord 2023; 37:215-221. [PMID: 37615486 DOI: 10.1097/wad.0000000000000573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/03/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To examine international variations in national diagnosis and certification habits prefer recording dementia (D) versus Alzhiemer disease (AD) as the underlying cause of death (UCOD) and their associations with mortality rates of dementia and AD. METHODS We calculated proportions of D/D+AD and AD/D+AD deaths as proxies of national diagnosis and certification habits. Pearson correlation coefficients (r) were estimated to assess the associations of proportions with the mortality rates of dementia or AD among adults aged 75 to 84 years across 38 countries. RESULTS The countries with a high preference for recording dementia as the UCOD were Taiwan and Latvia with proportion of D/D+AD deaths of 92% and 88%, respectively, and those with a high preference for recording AD as the UCOD were Slovenia, Turkey, and Poland with proportion of AD/D+AD deaths of 100%, 99%, and 89%, respectively. The r values for the proportions and mortality rate for dementia and AD were 0.67 (95% CI: 0.44-0.81) and 0.46 (95% CI: 0.16-0.68), respectively. CONCLUSION We identified a small number of countries with obvious natonal diagnosis and certification habits preferring dementia or AD and had moderate effects on international variations in the mortality rates of dementia and AD.
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Affiliation(s)
- Ying-Chen Chi
- Department of Healthcare Information & Management, School of Health Technology, Ming Chuan University, Taoyuan
| | - Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Hsin-Yun Chang
- Department of Family Medicine, Tainan Hospital, Ministry of Health and Welfare
- Institute of Allied Health Sciences
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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Suárez-Idueta L, Yargawa J, Blencowe H, Bradley E, Okwaraji YB, Pingray V, Gibbons L, Gordon A, Warrilow K, Paixao ES, Falcão IR, Lisonkova S, Wen Q, Mardones F, Caulier-Cisterna R, Velebil P, Jírová J, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Gissler M, Heidarzadeh M, Moradi-Lakeh M, Yunis KA, Al Bizri A, Karalasingam SD, Jeganathan R, Barranco A, Broeders L, van Dijk AE, Huicho L, Quezada-Pinedo HG, Cajachagua-Torres KN, Alyafei F, AlQubaisi M, Cho GJ, Kim HY, Razaz N, Söderling J, Smith LK, Kurinczuk J, Lowry E, Rowland N, Wood R, Monteath K, Pereyra I, Pravia G, Ohuma EO, Lawn JE. Vulnerable newborn types: Analysis of population-based registries for 165 million births in 23 countries, 2000-2021. BJOG 2023. [PMID: 37156241 DOI: 10.1111/1471-0528.17505] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/04/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To examine the prevalence of novel newborn types among 165 million live births in 23 countries from 2000 to 2021. DESIGN Population-based, multi-country analysis. SETTING National data systems in 23 middle- and high-income countries. POPULATION Liveborn infants. METHODS Country teams with high-quality data were invited to be part of the Vulnerable Newborn Measurement Collaboration. We classified live births by six newborn types based on gestational age information (preterm <37 weeks versus term ≥37 weeks) and size for gestational age defined as small (SGA, <10th centile), appropriate (10th-90th centiles), or large (LGA, >90th centile) for gestational age, according to INTERGROWTH-21st standards. We considered small newborn types of any combination of preterm or SGA, and term + LGA was considered large. Time trends were analysed using 3-year moving averages for small and large types. MAIN OUTCOME MEASURES Prevalence of six newborn types. RESULTS We analysed 165 017 419 live births and the median prevalence of small types was 11.7% - highest in Malaysia (26%) and Qatar (15.7%). Overall, 18.1% of newborns were large (term + LGA) and was highest in Estonia 28.8% and Denmark 25.9%. Time trends of small and large infants were relatively stable in most countries. CONCLUSIONS The distribution of newborn types varies across the 23 middle- and high-income countries. Small newborn types were highest in west Asian countries and large types were highest in Europe. To better understand the global patterns of these novel newborn types, more information is needed, especially from low- and middle-income countries.
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Affiliation(s)
| | - Judith Yargawa
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ellen Bradley
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Yemisrach B Okwaraji
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronica Pingray
- Department of Mother & Child Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Luz Gibbons
- Department of Mother & Child Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Adrienne Gordon
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kara Warrilow
- Centre for Research Excellence in Stillbirth, MRI-UQ, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Enny S Paixao
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz Bahia, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Ila Rocha Falcão
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz Bahia, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Sarka Lisonkova
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qi Wen
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Petr Velebil
- Department of Obstetrics and Gynaecology, Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Jitka Jírová
- Department of Data Analysis, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | | | | | - Luule Sakkeus
- School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Lili Abuladze
- School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Maziar Moradi-Lakeh
- Department of Community Medicine, Preventive Medicine and Public Health Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Khalid A Yunis
- Department of Paediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayah Al Bizri
- Department of Paediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Shamala D Karalasingam
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cyberjaya, Cyberjaya, Malaysia
| | - Ravichandran Jeganathan
- Department of Obstetrics & Gynaecology, Hospital Sultanah Aminah, Ministry of Health, Johor Bahru, Malaysia
| | - Arturo Barranco
- Directorate of Health Information, Ministry of Health, Mexico City, Mexico
| | | | | | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hugo Guillermo Quezada-Pinedo
- The Generation R Study Group, Department of Paediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Kim Nail Cajachagua-Torres
- The Generation R Study Group, Department of Paediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | | | - Geum Joon Cho
- Department of Obstetrics and Gynaecology, Korea University College of Medicine, Seoul, South Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynaecology, Korea University College of Medicine, Seoul, South Korea
| | - Neda Razaz
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lucy K Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jennifer Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Estelle Lowry
- School of Natural and Built Environment, Queen's University Belfast, Belfast, UK
| | - Neil Rowland
- Queen's Management School, Queen's University Belfast, Belfast, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kirsten Monteath
- Department of Maternity and Sexual Health Team, Public Health Scotland, Edinburgh, UK
| | - Isabel Pereyra
- Catholic University of the Maule, Región del Maule, Chile
- Department of Wellness and Health, Catholic University of Uruguay, Montevideo, Uruguay
| | - Gabriella Pravia
- Department of Wellness and Health, Catholic University of Uruguay, Montevideo, Uruguay
| | - Eric O Ohuma
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Teji JS, Jain S, Gupta SK, Suri JS. NeoAI 1.0: Machine learning-based paradigm for prediction of neonatal and infant risk of death. Comput Biol Med 2022; 147:105639. [DOI: 10.1016/j.compbiomed.2022.105639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022]
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Trinh NT, de Visme S, Cohen JF, Bruckner T, Lelong N, Adnot P, Rozé JC, Blondel B, Goffinet F, Rey G, Ancel PY, Zeitlin J, Chalumeau M. Recent historic increase of infant mortality in France: A time-series analysis, 2001 to 2019. Lancet Reg Health Eur 2022; 16:100339. [PMID: 35252944 PMCID: PMC8891691 DOI: 10.1016/j.lanepe.2022.100339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The infant mortality rate (IMR) serves as a key indicator of population health. Methods We used data from the French National Institute of Statistics and Economic Studies on births and deaths during the first year of life from 2001 to 2019 to calculate IMR aggregated by month. We ran joinpoint regressions to identify inflection points and assess the linear trend of each segment. Exploratory analyses were performed for overall IMR, as well as by age at death subgroups (early neonatal [D0-D6], late neonatal [D7-27], and post-neonatal [D28-364]), and by sex. We performed sensitivity analyses by excluding deaths at D0 and using other time-series modeling strategies. Results Over the 19-year study period, 53,077 infant deaths occurred, for an average IMR of 3·63/1000 (4·00 in male, 3·25 in female); 24·4% of these deaths occurred during the first day of life and 47·8% during the early neonatal period. Joinpoint analysis identified two inflection points in 2005 and 2012. The IMR decreased sharply from 2001 to 2005 (slope: -0·0167 deaths/1000 live births/month; 95%CI: -0·0219 to -0·0116) and then decreased slowly between 2005 and 2012 (slope: -0·0041; 95%CI: -0·0065 to -0·0016). From 2012 onwards, a significant increase in IMR was observed (slope: 0·0033; 95%CI: 0·0011 to 0·0056). Subgroup analyses indicated that these trends were driven notably by an increase in the early neonatal period. Sensitivity analyses provided consistent results. Interpretation The recent historic increase in IMR since 2012 in France should prompt urgent in-depth investigation to understand the causes and prepare corrective actions. Funding No financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.
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Nath S, Hardelid P, Zylbersztejn A. Are infant mortality rates increasing in England? The effect of extreme prematurity and early neonatal deaths. J Public Health (Oxf) 2021; 43:541-550. [PMID: 32119086 PMCID: PMC8458015 DOI: 10.1093/pubmed/fdaa025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/31/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infant mortality has been rising in England since 2014. We examined potential drivers of these trends. METHODS We used aggregate data on all live births, stillbirths and linked infant deaths in England in 2006-2016 from the Office for National Statistics. We compared trends in infant mortality rates overall, excluding births at <24 weeks of gestation, by quintile of SES and gestational age. RESULTS Infant mortality decreased from 4.78 deaths/1000 live births in 2006 to 3.54/1000 in 2014 (annual decrease of 0.15/1000) and increased to 3.67/1000 in 2016 (annual increase of 0.07/1000). This rise was driven by increases in deaths at 0-6 days of life. After excluding infants born at <24 weeks of gestation, infant mortality continued to decrease after 2014. The risk of infant death was 94% higher in the most versus least deprived SES quintile, which reduced to a 55% higher risk after adjusting for gestational age. CONCLUSIONS The observed increase in infant mortality rates since 2014 is wholly explained by an increasing number of deaths at 0-6 days of age among babies born at <24 weeks of gestation. Policies focused on improving maternal health to reduce preterm birth could substantially reduce the socio-economic gap in infant survival.
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Affiliation(s)
- Selina Nath
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Pia Hardelid
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Ania Zylbersztejn
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Loane M, Given JE, Tan J, Reid A, Akhmedzhanova D, Astolfi G, Barišić I, Bertille N, Bonet LB, Carbonell CC, Carollo OM, Coi A, Densem J, Draper E, Garne E, Gatt M, Glinianaia SV, Heino A, Hond ED, Jordan S, Khoshnood B, Kiuru-Kuhlefelt S, Klungsøyr K, Lelong N, Lutke LR, Neville AJ, Ostapchuk L, Puccini A, Rissmann A, Santoro M, Scanlon I, Thys G, Tucker D, Urhoj SK, de Walle HEK, Wellesley D, Zurriaga O, Morris JK. Linking a European cohort of children born with congenital anomalies to vital statistics and mortality records: A EUROlinkCAT study. PLoS One 2021; 16:e0256535. [PMID: 34449798 PMCID: PMC8396745 DOI: 10.1371/journal.pone.0256535] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
EUROCAT is a European network of population-based congenital anomaly (CA) registries. Twenty-one registries agreed to participate in the EUROlinkCAT study to determine if reliable information on the survival of children born with a major CA between 1995 and 2014 can be obtained through linkage to national vital statistics or mortality records. Live birth children with a CA could be linked using personal identifiers to either their national vital statistics (including birth records, death records, hospital records) or to mortality records only, depending on the data available within each region. In total, 18 of 21 registries with data on 192,862 children born with congenital anomalies participated in the study. One registry was unable to get ethical approval to participate and linkage was not possible for two registries due to local reasons. Eleven registries linked to vital statistics and seven registries linked to mortality records only; one of the latter only had identification numbers for 78% of cases, hence it was excluded from further analysis. For registries linking to vital statistics: six linked over 95% of their cases for all years and five were unable to link at least 85% of all live born CA children in the earlier years of the study. No estimate of linkage success could be calculated for registries linking to mortality records. Irrespective of linkage method, deaths that occurred during the first week of life were over three times less likely to be linked compared to deaths occurring after the first week of life. Linkage to vital statistics can provide accurate estimates of survival of children with CAs in some European countries. Bias arises when linkage is not successful, as early neonatal deaths were less likely to be linked. Linkage to mortality records only cannot be recommended, as linkage quality, and hence bias, cannot be assessed.
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Affiliation(s)
- M. Loane
- Faculty of Life and Health Sciences, Ulster University, Northern Ireland, United Kingdom
| | - J. E. Given
- Faculty of Life and Health Sciences, Ulster University, Northern Ireland, United Kingdom
| | - J. Tan
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - A. Reid
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - D. Akhmedzhanova
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - G. Astolfi
- Emilia Romagna Registry of Birth Defects, University Hospital of Ferrara, Ferrara, Italy
| | - I. Barišić
- Klinika za dječje bolesti, Zagreb, Croatia
| | - N. Bertille
- Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - L. B. Bonet
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - C. C. Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | | | - A. Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - J. Densem
- Biomedical Computing Limited, Battle, United Kingdom
| | - E. Draper
- East Midlands & South Yorkshire Congenital Anomaly Registry, University of Leicester, Leicester, United Kingdom
| | - E. Garne
- Hospital Lillebaelt, Region Syddanmark, Denmark
| | - M. Gatt
- Directorate for Health Information and Research, G’Mangia, Malta
| | - S. V. Glinianaia
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - A. Heino
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - E. Den Hond
- Provinciaal Instituut voor Hygiëne (PIH), Antwerpen, Belgium
| | - S. Jordan
- Swansea University, Wales, United Kingdom
| | - B. Khoshnood
- Institut National de la Santé et de la Recherche Médicale, Paris, France
| | | | - K. Klungsøyr
- Division of Mental and Physical Health, Department of Global Public Health and Primary Care, Norwegian Institute of Public Health, University of Bergen, Bergen, Norway
| | - N. Lelong
- Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - L. R. Lutke
- Department of Genetics, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - A. J. Neville
- Emilia Romagna Registry of Birth Defects, University Hospital of Ferrara, Ferrara, Italy
| | - L. Ostapchuk
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - A. Puccini
- Territorial Care Service, Emilia Romagna Health Authority, Bologna, Italy
| | - A. Rissmann
- Medical Faculty Otto-von-Guericke, Malformation Monitoring Centre Saxony-Anhalt, University Magdeburg, Magdeburg, Germany
| | - M. Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - I. Scanlon
- Swansea University, Wales, United Kingdom
| | - G. Thys
- Provinciaal Instituut voor Hygiëne (PIH), Antwerpen, Belgium
| | - D. Tucker
- Public Health Wales, Wales, United Kingdom
| | - S. K. Urhoj
- Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - H. E. K. de Walle
- Department of Genetics, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - D. Wellesley
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, United Kingdom
| | - O. Zurriaga
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - J. K. Morris
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
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11
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Harpur A, Minton J, Ramsay J, McCartney G, Fenton L, Campbell H, Wood R. Trends in infant mortality and stillbirth rates in Scotland by socio-economic position, 2000-2018: a longitudinal ecological study. BMC Public Health 2021; 21:995. [PMID: 34044796 PMCID: PMC8155799 DOI: 10.1186/s12889-021-10928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As Scotland strives to become a country where children flourish in their early years, it is faced with the challenge of socio-economic health inequalities, which are at risk of widening amidst austerity policies. The aim of this study was to explore trends in infant mortality rates (IMR) and stillbirth rates by socio-economic position (SEP) in Scotland, between 2000 and 2018, inclusive. METHODS Data for live births, infant deaths, and stillbirths between 2000 and 2018 were obtained from National Records of Scotland. Annual IMR and stillbirth rates were calculated and visualised for all of Scotland and when stratified by SEP. Negative binomial regression models were used to estimate the association between SEP and infant mortality and stillbirth events, and to assess for break points in trends over time. The slope (SII) and relative (RII) index of inequality compared absolute and relative socio-economic inequalities in IMR and stillbirth rates before and after 2010. RESULTS IMR fell from 5.7 to 3.2 deaths per 1000 live births between 2000 and 2018, with no change in trend identified. Stillbirth rates were relatively static between 2000 and 2008 but experienced accelerated reduction from 2009 onwards. When stratified by SEP, inequalities in IMR and stillbirth rates persisted throughout the study and were greatest amongst the sub-group of post-neonates. Although comparison of the SII and RII in IMR and stillbirths before and after 2010 suggested that inequalities remained stable, descriptive trends in mortality rates displayed a 3-year rise in the most deprived quintiles from 2016 onwards. CONCLUSION Whilst Scotland has experienced downward trends in IMR and stillbirth rates between 2000 and 2018, the persistence of socio-economic inequalities and suggestion that mortality rates amongst the most deprived groups may be worsening warrants further action to improve maternal health and strengthen support for families with young children.
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Affiliation(s)
- Alice Harpur
- The Usher Institute, The University of Edinburgh, Edinburgh, UK. .,Department of Public Health NHS Lothian, Edinburgh, UK.
| | | | | | | | | | - Harry Campbell
- The Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Rachael Wood
- The Usher Institute, The University of Edinburgh, Edinburgh, UK.,Public Health Scotland, Glasgow, UK
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12
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Joseph KS, Lee L, Arbour L, Auger N, Darling EK, Evans J, Little J, McDonald SD, Moore A, Murphy PA, Ray JG, Scott H, Shah P, VanDenHof M, Kramer MS. Stillbirth in Canada: anachronistic definition and registration processes impede public health surveillance and clinical care. Canadian Journal of Public Health 2021; 112:766-772. [PMID: 33742313 PMCID: PMC8225733 DOI: 10.17269/s41997-021-00483-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/27/2021] [Indexed: 12/05/2022]
Abstract
The archaic definition and registration processes for stillbirth currently prevalent in Canada impede both clinical care and public health. The situation is fraught because of definitional problems related to the inclusion of induced abortions at ≥20 weeks’ gestation as stillbirths: widespread uptake of prenatal diagnosis and induced abortion for serious congenital anomalies has resulted in an artefactual temporal increase in stillbirth rates in Canada and placed the country in an unfavourable position in international (stillbirth) rankings. Other problems with the Canadian stillbirth definition and registration processes extend to the inclusion of fetal reductions (for multi-fetal pregnancy) as stillbirths, and the use of inconsistent viability criteria for reporting stillbirth. This paper reviews the history of stillbirth registration in Canada, provides a rationale for updating the definition of fetal death and recommends a new definition and improved processes for fetal death registration. The recommendations proposed are intended to serve as a starting point for reformulating issues related to stillbirth, with the hope that building a consensus regarding a definition and registration procedures will facilitate clinical care and public health.
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Affiliation(s)
- K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital of British Columbia, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Lily Lee
- Perinatal Services BC, Vancouver, British Columbia, Canada
| | - Laura Arbour
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital of British Columbia, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Nathalie Auger
- Institut National de Santé Publique du Québec, Université de Montréal, Montréal, Québec, Canada
| | | | - Jane Evans
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Aideen Moore
- University of Toronto and Sick Kids Hospital, Toronto, Ontario, Canada
| | - Phil A Murphy
- Perinatal Program of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Joel G Ray
- University of Toronto and St. Michael's Hospital, Toronto, Ontario, Canada
| | - Heather Scott
- Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Prakesh Shah
- University of Toronto and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michiel VanDenHof
- Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada
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13
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Lee M, Hall ES, Taylor M, DeFranco EA. Regional Contribution of Previable Infant Deaths to Infant Mortality Rates in the United States. Am J Perinatol 2021; 38:158-165. [PMID: 31480083 DOI: 10.1055/s-0039-1695014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Lack of standardization of infant mortality rate (IMR) calculation between regions in the United States makes comparisons potentially biased. This study aimed to quantify differences in the contribution of early previable live births (<20 weeks) to U.S. regional IMR. STUDY DESIGN Population-based cohort study of all U.S. live births and infant deaths recorded between 2007 and 2014 using Centers for Disease Control and Prevention's (CDC's) WONDER database linked birth/infant death records (births from 17-47 weeks). Proportion of infant deaths attributable to births <20 vs. 20 to 47 weeks, and difference (ΔIMR) between reported and modified (births ≥20 weeks) IMRs were compared across four U.S. census regions (North, South, Midwest, and West). RESULTS Percentages of infant deaths attributable to birth <20 weeks were 6.3, 6.3, 5.3, and 4.1% of total deaths for Northeast, Midwest, South, and West, respectively, p < 0.001. Contribution of < 20-week deaths to each region's IMR was 0.34, 0.42, 0.37, and 0.2 per 1,000 live births. Modified IMR yielded less regional variation with IMRs of 5.1, 6.2, 6.6, and 4.9 per 1,000 live births. CONCLUSION Live births at <20 weeks contribute significantly to IMR as all result in infant death. Standardization of gestational age cut-off results in more consistent IMRs among U.S. regions and would result in U.S. IMR rates exceeding the healthy people 2020 goal of 6.0 per 1,000 live births.
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Affiliation(s)
- MacKenzie Lee
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eric S Hall
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Meredith Taylor
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily A DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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14
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Donoso E, Carvajal JA. Epidemiological difference could explain the higher infant mortality in Chile compared with Cuba. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.anpede.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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15
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Donoso E, Carvajal JA. [Epidemiological difference could explain the higher infant mortality in Chile compared with Cuba]. An Pediatr (Barc) 2020; 94:28-35. [PMID: 32444314 DOI: 10.1016/j.anpedi.2020.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Cuba has the lowest infant mortality rate in Latin America, while Chile has an infant mortality rate above the average of Organization for Economic Cooperation and Development (OECD) countries. OBJECTIVE To compare the epidemiology of infant mortality between Chile and Cuba in order to find characteristics that may explain the differences found. METHOD Comparative analysis between Chile and Cuba of infant mortality rate, causes of mortality, live birth weight, and maternal age, in 2015. RESULTS Cuba had a lower infant, neonatal, early and late mortality than Chile, with no differences in post-neonatal mortality. Chile had a higher infant mortality due to, alterations of the nervous system, urinary system, chromosomal alterations, respiratory distress syndrome, and disorders related to the short duration of gestation. Chile had a higher frequency of mothers ≥ 35 years old and live births weighing <2,500 g. The possible effects of health inequities could not be analyzed due to lack of data. CONCLUSIONS It is possible to attribute the lower infant mortality rate in Cuba to: selective abortion due to congenital malformations and chromosomal anomalies, lower epidemiological risk of the Cuban pregnant population, and lower frequency of live births with low birth weight.
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Affiliation(s)
- Enrique Donoso
- División de Obstetricia y Ginecología, Departamento de Obstetricia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Jorge A Carvajal
- División de Obstetricia y Ginecología, Departamento de Obstetricia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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16
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Lebreton E, Crenn-Hebert C, Menguy C, Howell EA, Gould JB, Dechartres A, Zeitlin J. Composite neonatal morbidity indicators using hospital discharge data: A systematic review. Paediatr Perinat Epidemiol 2020; 34:350-365. [PMID: 32207172 PMCID: PMC7418783 DOI: 10.1111/ppe.12665] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/13/2020] [Accepted: 02/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal morbidity is associated with lifelong impairments, but the absence of a consensual definition and the need for large data sets limit research. OBJECTIVES To inform initiatives to define standard outcomes for research, we reviewed composite neonatal morbidity indicators derived from routine hospital discharge data. DATA SOURCES PubMed (updated on October 12, 2018). The search algorithm was based on three components: "morbidity," "neonatal," and "hospital discharge data." STUDY SELECTION AND DATA EXTRACTION Studies investigating neonatal morbidity using a composite indicator based on hospital discharge data were included. Indicators defined for specific conditions (eg congenital anomalies, maternal addictions) were excluded. The target population, objectives, component morbidities, diagnosis and procedure codes, validation methods, and prevalence of morbidity were extracted. SYNTHESIS For each study, we assessed construct validity by describing the methods used to select the indicator components and evaluated whether the authors assessed internal and external validity. We also calculated confidence intervals for the prevalence of the morbidity composite. RESULTS Seventeen studies fulfilled inclusion criteria. Indicators targeted all (n = 4), low-/moderate-risk (n = 9), and very preterm (VPT, n = 4) infants. Components were similar for VPT infants, but domains and diagnosis codes within domains varied widely for all and low-/moderate-risk infants. Component selection was described for 8/17 indicators and some form of validation reported for 12/17. Neonatal morbidity prevalence ranged from 4.6% to 9.0% of all infants, 0.4% to 8.0% of low-/moderate-risk infants, and 17.8% to 61.0% of VPT infants. CONCLUSIONS Multiple neonatal morbidity indicators based on hospital discharge data have been used for research, but their heterogeneity limits comparisons between studies. Standard neonatal outcome measures are needed for benchmarking and synthesis of research results.
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Affiliation(s)
- Elodie Lebreton
- Data Science and Analytics Department, SESAN, Paris, France,Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, F-75004 Paris, France,Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Paris, France
| | - Catherine Crenn-Hebert
- Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Paris, France,Maternity unit, Louis Mourier University Hospital, APHP, Colombes, France
| | - Claudie Menguy
- Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Paris, France,Department of Medical Information, André Grégoire Hospital, Montreuil, France
| | - Elizabeth A. Howell
- Women’s Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, and Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey B. Gould
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Agnès Dechartres
- Sorbonne Université, Inserm U1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département Biostatistique, santé publique, information médicale - Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, F-75004 Paris, France
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17
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Fell DB, Park AL, Sprague AE, Islam N, Ray JG. A new record linkage for assessing infant mortality rates in Ontario, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2020; 111:278-285. [PMID: 31858437 PMCID: PMC7109219 DOI: 10.17269/s41997-019-00265-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 09/20/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Infant mortality statistics for Canada have routinely omitted Ontario-Canada's most populous province-as a high proportion of Vital Statistics infant death registrations could not be linked with their corresponding Vital Statistics live birth registrations. We assessed the feasibility of linking an alternative source of live birth information with infant death registrations. METHODS All infant deaths occurring before 365 days of age registered in Ontario's Vital Statistics in 2010-2011 were linked with birth records in the Canadian Institute for Health Information's hospitalization database. Crude birthweight-specific and gestational age-specific infant mortality rates were calculated, and rates examined according to maternal and infant characteristics. RESULTS Of 1311 infant death registrations, only 47 (3.6%) could not be linked to a hospital birth record. The overall crude infant mortality rate was 4.7 deaths per 1000 live births (95% CI, 4.4 to 4.9), the same as previously reported for the rest of Canada in 2011. Infant mortality was higher in women < 20 years (5.8 per 1000 live births) and ≥ 40 years (5.9 per 1000 live births), and lowest among those aged 25-29 years (3.9 per 1000 live births). Infant mortality was notably higher in the lowest (5.1 per 1000 live births) residential income quintile than the highest (3.4 per 1000 live births). CONCLUSION Use of birth hospitalization records resulted in near-complete linkage of all Vital Statistics infant death registrations. This approach could enhance the conduct of representative surveillance and research on infant mortality when direct linkage of live birth and infant death registrations is not achievable.
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Affiliation(s)
- Deshayne B Fell
- University of Ottawa, Ottawa, Ontario, Canada.
- ICES, Ontario, Canada.
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Centre for Practice Changing Research, 401 Smyth Road, Room L-1154, Ottawa, Ontario, K1H 8L1, Canada.
| | | | - Ann E Sprague
- University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Centre for Practice Changing Research, 401 Smyth Road, Room L-1154, Ottawa, Ontario, K1H 8L1, Canada
- Better Outcomes Registry & Network, Ottawa, Ontario, Canada
| | - Nehal Islam
- University of Ottawa, Ottawa, Ontario, Canada
| | - Joel G Ray
- Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Canada
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18
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Smith LK, Dickens J, Bender Atik R, Bevan C, Fisher J, Hinton L. Parents' experiences of care following the loss of a baby at the margins between miscarriage, stillbirth and neonatal death: a UK qualitative study. BJOG 2020; 127:868-874. [PMID: 31976622 PMCID: PMC7383869 DOI: 10.1111/1471-0528.16113] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore the healthcare experiences of parents whose baby died either before, during or shortly after birth between 20+0 and 23+6 weeks of gestation in order to identify practical ways to improve healthcare provision. DESIGN Qualitative interview study. SETTING England through two parent support organisations and four NHS Trusts. SAMPLE A purposive sample of parents. METHODS Thematic analysis of semi-structured in-depth narrative interviews. MAIN OUTCOME MEASURES Parents' healthcare experiences. RESULTS The key overarching theme to emerge from interviews with 38 parents was the importance of the terminology used to refer to the death of their baby. Parents who were told they were 'losing a baby' rather than 'having a miscarriage' were more prepared for the realities of labour, the birth experience and for making decisions around seeing and holding their baby. Appropriate terminology validated their loss, and impacted on parents' health and wellbeing immediately following bereavement and in the longer term. CONCLUSION For parents experiencing the death of their baby at the margins between miscarriage, stillbirth and neonatal death, ensuring the use of appropriate terminology that reflects parents' preferences is vital. This helps to validate their loss and prepare them for the experiences of labour and birth. Reflecting parents' language preferences combined with compassionate bereavement care is likely to have a positive impact on parents' experiences and improve longer-term outcomes. TWEETABLE ABSTRACT Describing baby loss shortly before 24 weeks of gestation as a 'miscarriage' does not prepare parents for labour and birth, seeing their baby and making memories.
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Affiliation(s)
- LK Smith
- Department of Health SciencesUniversity of LeicesterLeicesterUK
| | - J Dickens
- Bereavement Specialist MidwifeUniversity Hospitals of Leicester NHS TrustUniversity of LeicesterLeicesterUK
| | | | - C Bevan
- Sands, the Stillbirth and Neonatal Death CharityLondonUK
| | - J Fisher
- Antenatal Results and ChoicesLondonUK
| | - L Hinton
- Applied Research, Health Experiences Research GroupNuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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19
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Daodu OO, Zondervan N, Urban D, MacRobie A, Brindle M. Deriving literature-based benchmarks for pediatric appendectomy and cholecystectomy complications from national databases in high-income countries: A systematic review and meta-analysis. J Pediatr Surg 2019; 54:2528-2538. [PMID: 31575414 DOI: 10.1016/j.jpedsurg.2019.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Health systems must identify preventable adverse outcomes to improve surgical safety. We conducted a systematic review to determine national rates of postoperative complications associated with two common pediatric surgery operations in High-Income Countries (HICs). METHODS National database studies of complication rates associated with pediatric appendectomies and cholecystectomies (2000-2016) in Canada, the US, and the UK were included. Outcomes included mortality, length of hospital stay (LOS), and other surgical complications. Outcome data were extracted and comparisons made between countries and databases. RESULTS Thirty-three papers met inclusion criteria (1 Canadian, 1 UK, and 4 US Databases). Mean LOS was 3.00 (±1.42) days and 3.44 (±1.55) days for appendectomy and cholecystectomy, respectively. Mortality was 0.06% after appendectomy and 0.24% after cholecystectomy. Readmission and reoperation rates were 6.79% and 0.32% for appendectomy, and 1.37% and 0.71% for cholecystectomy. For appendectomies, LOS was shorter in Canadian and UK studies compared to US studies, and mortality and readmission rates were lower (OR 0.46 95%CI 0.23 to 0.93, OR 3.63 to 3.77 95%CI) in UK studies compared to US studies. CONCLUSIONS Outcomes after pediatric appendectomy and cholecystectomy are good but vary between HICs. Understanding national outcomes and intercountry differences is essential in developing health system approaches to pediatric surgical safety. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Nathan Zondervan
- Department of Surgery, Cumming School of Medicine, University of Calgary, Foothills Medical Centre Calgary, Alberta, Canada
| | - Denisa Urban
- Section of Pediatric Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Ali MacRobie
- Section of Pediatric Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Mary Brindle
- Section of Pediatric Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Foothills Medical Centre Calgary, Alberta, Canada.
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20
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Smith LK, Blondel B, Zeitlin J. Producing valid statistics when legislation, culture and medical practices differ for births at or before the threshold of survival: report of a European workshop. BJOG 2019; 127:314-318. [PMID: 31580509 PMCID: PMC7003918 DOI: 10.1111/1471-0528.15971] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- L K Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - B Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - J Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
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21
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Adane AA, Bailey HD, Marriott R, Farrant BM, White SW, Stanley FJ, Shepherd CCJ. Disparities between Aboriginal and non-Aboriginal perinatal mortality rates in Western Australia from 1980 to 2015. Paediatr Perinat Epidemiol 2019; 33:412-420. [PMID: 31518017 DOI: 10.1111/ppe.12580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perinatal mortality rates are typically higher in Aboriginal than non-Aboriginal populations of Australia. OBJECTIVES This study aimed to examine the pattern of stillbirth and neonatal mortality rate disparities over time in Western Australia, including an evaluation of these disparities across gestational age groupings. METHODS All singleton births (≥20 weeks gestation) in Western Australia between 1980 and 2015 were included. Linked data were obtained from core population health datasets of Western Australia. Stillbirth and neonatal mortality rates and percentage changes in the rates over time were calculated by Aboriginal status and gestational age categories. RESULTS From 1980 to 2015, data were available for 930 926 births (925 715 livebirths, 5211 stillbirths and 2476 neonatal deaths). Over the study period, there was a substantial reduction in both the Aboriginal (19.6%) and non-Aboriginal (32.3%) stillbirth rates. These reductions were evident in most gestational age categories among non-Aboriginal births and in Aboriginal term births. Concomitantly, neonatal mortality rates decreased in all gestational age windows for both populations, ranging from 32.1% to 77.5%. The overall stillbirth and neonatal mortality rate differences between Aboriginal and non-Aboriginal birth decreased by 0.6 per 1000 births and 3.9 per 1000 livebirths, respectively, although the rate ratios (RR 2.51, 95% CI 2.14, 2.94) and (RR 2.94, 95% CI 2.24, 3.85), respectively reflect a persistent excess of Aboriginal perinatal mortality across the study period. CONCLUSIONS Despite steady improvements in perinatal mortality rates in Western Australia over 3½ decades, the gap between Aboriginal and non-Aboriginal rates remains unchanged in relative terms. There is a continuing, pressing need to address modifiable risk factors for preventable early mortality in Aboriginal populations.
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Affiliation(s)
- Akilew A Adane
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Helen D Bailey
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Rhonda Marriott
- Ngangk Yira Research Centre, Murdoch University, Perth, WA, Australia
| | - Brad M Farrant
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Fiona J Stanley
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia.,Ngangk Yira Research Centre, Murdoch University, Perth, WA, Australia
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22
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Schneuer FJ, Bell JC, Shand AW, Walker K, Badawi N, Nassar N. Five-year survival of infants with major congenital anomalies: a registry based study. Acta Paediatr 2019; 108:2008-2018. [PMID: 31046172 DOI: 10.1111/apa.14833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/04/2019] [Accepted: 04/29/2019] [Indexed: 12/28/2022]
Abstract
AIM To determine survival of infants with major congenital anomalies (CA) and assess the effect of co-existing anomalies and gestational age. METHODS All liveborn infants with major CA born in New South Wales (NSW), Australia, 2004-2009 were identified from the NSW Register of Congenital Conditions. Deaths were identified via record linkage to death registrations and five-year survival was estimated using Kaplan-Meier methods. RESULTS There were 8521 liveborn infants with CA of whom 617 (7.2%) died within the first five years of life. Half of deaths occurred in the first week of life. The overall five-year survival rate was 92.8% (95%CI: 92.2-93.3) and 83.2% (95%CI: 79.0-87.4) for syndromes, 83.4% (95%CI: 80.9-85.9) for multiple, 85.1% (95%CI: 82.6-87.5) for chromosomal, 95.3% (95%CI: 94.8-95.8) for isolated and 96.2% (95%CI: 94.3-98.1) for non-Q chapter anomalies. Five-year survival for chromosomal, syndromes and sub-groups was higher for isolated compared with multiple anomalies ranging from 77.5% to 98.9% and 68.6% to 89.5%, respectively. Survival was lower for preterm (79.4%; 95%CI: 77.5-81.4) than for term infants (95.8%; 95%CI: 95.3-96.3). CONCLUSION Nine in ten infants with major CA survive up to five years, although there is variability in survival across CA groups. Survival of infants with major congenital anomalies has improved in recent years.
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Affiliation(s)
- Francisco J. Schneuer
- Child Population and Translational Health Research The Children's Hospital at Westmead Clinical School The University of Sydney Sydney New South Wales Australia
| | - Jane C. Bell
- Child Population and Translational Health Research The Children's Hospital at Westmead Clinical School The University of Sydney Sydney New South Wales Australia
| | - Antonia W. Shand
- Child Population and Translational Health Research The Children's Hospital at Westmead Clinical School The University of Sydney Sydney New South Wales Australia
- Department of Maternal Fetal Medicine Royal Hospital for Women Randwick New South Wales Australia
| | - Karen Walker
- Grace Centre for Newborn Care The Children's Hospital at Westmead Westmead New South Wales Australia
- The Children's Hospital Westmead Clinical School The University of Sydney Westmead New South Wales Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care The Children's Hospital at Westmead Westmead New South Wales Australia
- The Children's Hospital Westmead Clinical School The University of Sydney Westmead New South Wales Australia
- Cerebral Palsy Research Institute Brain Mind Centre The University of Sydney Westmead New South Wales Australia
| | - Natasha Nassar
- Child Population and Translational Health Research The Children's Hospital at Westmead Clinical School The University of Sydney Sydney New South Wales Australia
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23
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Sørbye IK, Vangen S, Juarez SP, Bolumar F, Morisaki N, Gissler M, Andersen AMN, Racape J, Small R, Wood R, Urquia ML. Birthweight of babies born to migrant mothers - What role do integration policies play? SSM Popul Health 2019; 9:100503. [PMID: 31993489 PMCID: PMC6978482 DOI: 10.1016/j.ssmph.2019.100503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 11/18/2022] Open
Abstract
Birthweights of babies born to migrant women are generally lower than those of babies born to native-born women. Favourable integration policies may improve migrants’ living conditions and contribute to higher birthweights. We aimed to explore associations between integration policies, captured by the Migrant Integration Policy Index (MIPEX), with offspring birthweight among migrants from various world regions. In this cross-country study we pooled 31 million term birth records between 1998 and 2014 from ten high-income countries: Australia, Belgium, Canada, Denmark, Finland, Japan, Norway, Spain, Sweden and United Kingdom (Scotland). Birthweight differences in grams (g) were analysed with regression analysis for aggregate data and random effects models. Proportion of births to migrant women varied from 2% in Japan to 28% in Australia. The MIPEX score was not associated with birthweight in most migrant groups, but was positively associated among native-born (mean birthweight difference associated with a 10-unit increase in MIPEX: 105 g; 95% CI: 24, 186). Birthweight among migrants was highest in the Nordic countries and lowest in Japan and Belgium. Migrants from a given origin had heavier newborns in countries where the mean birthweight of native-born was higher and vice versa. Mean birthweight differences between migrants from the same origin and the native-born varied substantially across destinations (70 g–285 g). Birthweight among migrants does not correlate with MIPEX scores. However, birthweight of migrant groups aligned better with that of the native-born in destination counties. Further studies may clarify which broader social policies support migrant women and have impacts on perinatal outcomes. Favourable migrant integration policies, as measured by the MIPEX, did not correlate with offspring birthweight among migrants. However, the MIPEX correlated with birthweight among the offspring of native-born women. Migrants' birthweights were higher in countries with high birthweights in the local population and vice versa. Birthweight among native-born seems to have a pull-effect on the birthweight of migrant groups.
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Affiliation(s)
- Ingvil K. Sørbye
- Norwegian Advisory Unit for Women's Health, Department of Obstetrics, Oslo University Hospital, Norway
- Corresponding author. Norwegian Advisory Unit for Women's health, Department of Obstetrics, Oslo University Hospital, 0027, Oslo, Norway.
| | - Siri Vangen
- Norwegian Advisory Unit for Women's Health, Department of Obstetrics, Oslo University Hospital, Norway
| | - Sol P. Juarez
- Department of Public Health Sciences, Stockholm University, Sweden
| | - Francisco Bolumar
- Unit of Public Health, School of Medicine, University of Alcalá, Madrid, Spain
- City University of New York School of Public Health, New York, United States
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Japan
| | - Mika Gissler
- THL National Institute for Health and Welfare, Information Services Department, Helsinki, Finland
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
| | | | - Judith Racape
- École de Santé Publique, Faculté de Médecine, Université Libre de Bruxelles, Belgium
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Rachael Wood
- NHS National Services Scotland, Information Services Division, Edinburgh, Scotland, UK
| | - Marcelo L. Urquia
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Ontario, Canada
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24
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Zeitlin J, Alexander S, Barros H, Blondel B, Delnord M, Durox M, Gissler M, Hindori-Mohangoo AD, Hocquette A, Szamotulska K, Macfarlane A. Perinatal health monitoring through a European lens: eight lessons from the Euro-Peristat report on 2015 births. BJOG 2019; 126:1518-1522. [PMID: 31260601 DOI: 10.1111/1471-0528.15857] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 12/01/2022]
Affiliation(s)
- J Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - S Alexander
- Perinatal Epidemiology and Reproductive Health Unit, CR2, School of Public Health, ULB, Brussels, Belgium
| | - H Barros
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal
| | - B Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - M Delnord
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - M Durox
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - M Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - A D Hindori-Mohangoo
- Department Child Health, Netherlands Organisation for Applied Scientific Research, TNO Healthy Living, Leiden, the Netherlands.,Perinatal Interventions Suriname, Perisur Foundation, Paramaribo, Suriname.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - A Hocquette
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - K Szamotulska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - A Macfarlane
- Centre for Maternal and Child Health Research, City, University of London, London, UK
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25
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McAlister FA, Cram P, Bell CM. Comparing Canadian health care to that in other countries: looking beyond the headlines. CMAJ 2019; 190:E207-E208. [PMID: 29483328 DOI: 10.1503/cmaj.171527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Finlay A McAlister
- Faculty of Medicine and Dentistry (McAlister), University of Alberta, Edmonton, Alta.; Department of Medicine (Cram, Bell), University of Toronto, Toronto, Ont.
| | - Peter Cram
- Faculty of Medicine and Dentistry (McAlister), University of Alberta, Edmonton, Alta.; Department of Medicine (Cram, Bell), University of Toronto, Toronto, Ont
| | - Chaim M Bell
- Faculty of Medicine and Dentistry (McAlister), University of Alberta, Edmonton, Alta.; Department of Medicine (Cram, Bell), University of Toronto, Toronto, Ont
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26
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Gianino MM, Lenzi J, Bonaudo M, Fantini MP, Siliquini R, Ricciardi W, Damiani G. Patterns of amenable child mortality over time in 34 member countries of the Organisation for Economic Co-operation and Development (OECD): evidence from a 15-year time trend analysis (2001-2015). BMJ Open 2019; 9:e027909. [PMID: 31122996 PMCID: PMC6538061 DOI: 10.1136/bmjopen-2018-027909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To analyse the trends of amenable mortality rates (AMRs) in children over the period 2001-2015. DESIGN Time trend analysis. SETTING Thirty-four member countries of the Organisation for Economic Co-operation and Development (OECD). PARTICIPANTS Midyear estimates of the resident population aged ≤14 years. PRIMARY AND SECONDARY OUTCOME MEASURES Using data from the WHO Mortality Database and Nolte and McKee's list, AMRs were calculated as the annual number of deaths over the population/100 000 inhabitants. The rates were stratified by age groups (<1, 1-4, 5-9 and 10-14 years). All data were summarised by presenting the average rates for the years 2001/2005, 2006/2010 and 2011/2015. RESULTS There was a significant decline in children's AMRs in the <1 year group in all 34 OECD countries from 2001/2005 to 2006/2010 (332.78 to 295.17/100 000; %Δ -11.30%; 95% CI -18.75% to -3.85%) and from 2006/2010 to 2011/2015 (295.17 to 240.22/100 000; %Δ -18.62%; 95% CI -26.53% to -10.70%) and a slow decline in the other age classes. The only cause of death that was significantly reduced was conditions originating in the early neonatal period for the <1 year group. The age-specific distribution of causes of death did not vary significantly over the study period. CONCLUSIONS The low decline in amenable mortality rates for children aged ≥1 year, the large variation in amenable mortality rates across countries and the insufficient success in reducing mortality from all causes suggest that the heath system should increase its efforts to enhance child survival. Promoting models of comanagement between primary care and subspecialty services, encouraging high-quality healthcare and knowledge, financing universal access to healthcare and adopting best practice guidelines might help reduce amenable child mortality.
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Affiliation(s)
- Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università degli Studi di Torino, Torino, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Marco Bonaudo
- Department of Public Health Sciences and Pediatrics, Università degli Studi di Torino, Torino, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences and Pediatrics, Università degli Studi di Torino, Torino, Italy
| | - Walter Ricciardi
- Istituto di Sanità Pubblica, Universita Cattolica del Sacro Cuore Sede di Roma, Roma, Lazio, Italy
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, Roma, Italy
| | - Gianfranco Damiani
- Istituto di Sanità Pubblica, Universita Cattolica del Sacro Cuore Sede di Roma, Roma, Lazio, Italy
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, Roma, Italy
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27
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Liang FW, Chen M, Wu MH, Lue HC, Chiang TL, Lu TH. Infant mortality rates based on two registration criteria for live births: A comparison of Taiwan with 26 European countries. Pediatr Neonatol 2019; 60:224-226. [PMID: 30031807 DOI: 10.1016/j.pedneo.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 04/20/2018] [Accepted: 06/21/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Fu-Wen Liang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Min Chen
- Department of Census, Director-General of Budget, Executive Yuan, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Tung-Liang Chiang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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28
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Abstract
The United States' health care system is often compared with those of other industrialized countries, and consistently ranks poorly in terms of health care delivery, efficiency, and quality. However, there are several considerations unique to the United States that are often distorted in these analyses, and when considered in the context of the convoluted ethnic and social disparities that persist in the United States, the successes of the American health care system become more apparent.
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29
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Delnord M, Zeitlin J. Epidemiology of late preterm and early term births - An international perspective. Semin Fetal Neonatal Med 2019; 24:3-10. [PMID: 30309813 DOI: 10.1016/j.siny.2018.09.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Late preterm (34-36 weeks of gestational age (GA)), and early term (37-38 weeks GA) birth rates among singleton live births vary from 3% to 6% and from 15% to 31%, respectively, across countries, although data from low- and middle-income countries are sparse. Countries with high preterm birth rates are more likely to have high early term birth rates; many risk factors are shared, including pregnancy complications (hypertension, diabetes), medical practices (provider-initiated delivery, assisted reproduction), maternal socio-demographic and lifestyle characteristics and environmental factors. Exceptions include nulliparity and inflammation which increase risks for preterm, but not early term birth. Birth before 39 weeks GA is associated with adverse child health outcomes across a wide range of settings. International rate variations suggest that reductions in early delivery are achievable; implementation of best practice guidelines for obstetrical interventions and public health policies targeting population risk factors could contribute to prevention of both late preterm and early term births.
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Affiliation(s)
- Marie Delnord
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
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30
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Ahrens KA, Nelson H, Stidd RL, Moskosky S, Hutcheon JA. Short interpregnancy intervals and adverse perinatal outcomes in high-resource settings: An updated systematic review. Paediatr Perinat Epidemiol 2019; 33:O25-O47. [PMID: 30353935 PMCID: PMC7379643 DOI: 10.1111/ppe.12503] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND This systematic review summarises association between short interpregnancy intervals and adverse perinatal health outcomes in high-resource settings to inform recommendations for healthy birth spacing for the United States. METHODS Five databases and a previous systematic review were searched for relevant articles published between 1966 and 1 May 2017. We included studies meeting the following criteria: (a) reporting of perinatal health outcomes after a short interpregnancy interval since last livebirth; (b) conducted within a high-resource setting; and (c) estimates were adjusted for maternal age and at least one socio-economic factor. RESULTS Nine good-quality and 18 fair-quality studies were identified. Interpregnancy intervals <6 months were associated with a clinically and statistically significant increased risk of adverse outcomes in studies of preterm birth (eg, aOR ≥ 1.20 in 10 of 14 studies); spontaneous preterm birth (eg, aOR ≥ 1.20 in one of two studies); small-for-gestational age (eg, aOR ≥ 1.20 in 5 of 11 studies); and infant mortality (eg, aOR ≥ 1.20 in four of four studies), while four studies of perinatal death showed no association. Interpregnancy intervals of 6-11 and 12-17 months generally had smaller point estimates and confidence intervals that included the null. Most studies were population-based and few included adjustment for detailed measures of key confounders. CONCLUSIONS In high-resource settings, there is some evidence showing interpregnancy intervals <6 months since last livebirth are associated with increased risks for preterm birth, small-for-gestational age and infant death; however, results were inconsistent. Additional research controlling for confounding would further inform recommendations for healthy birth spacing for the United States.
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Affiliation(s)
- Katherine A. Ahrens
- Office of Population AffairsOffice of the Assistant Secretary for HealthU.S. Department of Health and Human ServicesRockvilleMaryland
| | - Heidi Nelson
- Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregon
| | | | - Susan Moskosky
- Office of Population AffairsOffice of the Assistant Secretary for HealthU.S. Department of Health and Human ServicesRockvilleMaryland
| | - Jennifer A. Hutcheon
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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31
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McGready R, Paw MK, Wiladphaingern J, Min AM, Carrara VI, Moore KA, Pukrittayakamee S, Nosten FH. The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the Thailand-Myanmar border: a population cohort study. Wellcome Open Res 2018; 1:32. [PMID: 30607368 PMCID: PMC6305214 DOI: 10.12688/wellcomeopenres.10352.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 02/05/2023] Open
Abstract
Background: No universal demarcation of gestational age distinguishes miscarriage and stillbirth or extreme preterm birth (exPTB). This study provides a synopsis of outcome between 22 to <28 weeks gestation from a low resource setting. Methods: A retrospective record review of a population on the Thailand-Myanmar border was conducted. Outcomes were classified as miscarriage, late expulsion of products between 22 to < 28 weeks gestation with evidence of non-viability (mostly ultrasound absent fetal heart beat) prior to 22 weeks; or exPTB (stillbirth/live born) between 22 to < 28 weeks gestation when the fetus was viable at ≥22 weeks. Termination of pregnancy and gestational trophoblastic disease were excluded. Results: From 1995-2015, 80.9% (50,046/ 61,829) of registered women had a known pregnancy outcome, of whom 99.8% (49,931) had a known gestational age. Delivery between 22 to <28 weeks gestation included 0.9% (472/49,931) of pregnancies after removing 18 cases (3.8%) who met an exclusion criteria. Most pregnancies had an ultrasound: 72.5% (n=329/454); 43.6% (n=197) were classified as miscarriage and 56.4% (n=257) exPTB. Individual record review of miscarriages estimated that fetal death had occurred at a median of 16 weeks, despite late expulsion between 22 to <28 weeks. With available data (n=252, 5 missing) the proportion of stillbirth was 47.6% (n=120), congenital abnormality 10.5% (24/228, 29 missing) and neonatal death was 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as exPTB rather than miscarriage. Conclusion: In this low resource setting few (<1%) pregnancy outcomes occurred in the 22 to <28 weeks gestational window; four in ten were miscarriage (late expulsion) and neonatal mortality approached 100%. In the scale-up to preventable newborns deaths (at least initially) greater benefits will be obtained by focusing on the viable newborns of ≥ 28 weeks gestation.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Verena I Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Department of Medicine, Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland
| | - Kerryn A Moore
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia
| | | | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
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32
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McGready R, Paw MK, Wiladphaingern J, Min AM, Carrara VI, Moore KA, Pukrittayakamee S, Nosten FH. The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the Thailand-Myanmar border: a population cohort study. Wellcome Open Res 2018; 1:32. [PMID: 30607368 DOI: 10.12688/wellcomeopenres.10352.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 12/21/2022] Open
Abstract
Background : No universal demarcation of gestational age distinguishes miscarriage and stillbirth or extreme preterm birth (exPTB). This study provides a synopsis of outcome between 22 to <28 weeks gestation from a low resource setting. Methods : A retrospective record review of a population on the Thailand-Myanmar border was conducted. Outcomes were classified as miscarriage, late expulsion of products between 22 to < 28 weeks gestation with evidence of non-viability (mostly ultrasound absent fetal heart beat) prior to 22 weeks; or exPTB (stillbirth/live born) between 22 to < 28 weeks gestation when the fetus was viable at ≥22 weeks. Termination of pregnancy and gestational trophoblastic disease were excluded. Results : From 1995-2015, 80.9% (50,046/ 61,829) of registered women had a known pregnancy outcome, of whom 99.8% (49,931) had a known gestational age. Delivery between 22 to <28 weeks gestation included 0.9% (472/49,931) of pregnancies after removing 18 cases (3.8%) who met an exclusion criteria. Most pregnancies had an ultrasound: 72.5% (n=329/454); 43.6% (n=197) were classified as miscarriage and 56.4% (n=257) exPTB. Individual record review of miscarriages estimated that fetal death had occurred at a median of 16 weeks, despite late expulsion between 22 to <28 weeks. With available data (n=252, 5 missing) the proportion of stillbirth was 47.6% (n=120), congenital abnormality 10.5% (24/228, 29 missing) and neonatal death was 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as exPTB rather than miscarriage. Conclusion : In this low resource setting few (<1%) pregnancy outcomes occurred in the 22 to <28 weeks gestational window; four in ten were miscarriage (late expulsion) and neonatal mortality approached 100%. In the scale-up to preventable newborns deaths (at least initially) greater benefits will be obtained by focusing on the viable newborns of ≥ 28 weeks gestation.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Verena I Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Department of Medicine, Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland
| | - Kerryn A Moore
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia
| | | | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
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Smith LK, Hindori-Mohangoo AD, Delnord M, Durox M, Szamotulska K, Macfarlane A, Alexander S, Barros H, Gissler M, Blondel B, Zeitlin J. Quantifying the burden of stillbirths before 28 weeks of completed gestational age in high-income countries: a population-based study of 19 European countries. Lancet 2018; 392:1639-1646. [PMID: 30269877 DOI: 10.1016/s0140-6736(18)31651-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/05/2018] [Accepted: 07/12/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND International comparisons of stillbirth allow assessment of variations in clinical practice to reduce mortality. Currently, such comparisons include only stillbirths from 28 or more completed weeks of gestational age, which underestimates the true burden of stillbirth. With increased registration of early stillbirths in high-income countries, we assessed the reliability of including stillbirths before 28 completed weeks in such comparisons. METHODS In this population-based study, we used national cohort data from 19 European countries participating in the Euro-Peristat project on livebirths and stillbirths from 22 completed weeks of gestation in 2004, 2010, and 2015. We excluded countries without national data for stillbirths by gestational age in these periods, or where data available were not comparable between 2004 and 2015. We also excluded those countries with fewer than 10 000 births per year because the proportion of stillbirths at 22 weeks to less than 28 weeks of gestation is small. We calculated pooled stillbirth rates using a random-effects model and changes in rates between 2004 and 2015 using risk ratios (RR) by gestational age and country. FINDINGS Stillbirths at 22 weeks to less than 28 weeks of gestation accounted for 32% of all stillbirths in 2015. The pooled stillbirth rate at 24 weeks to less than 28 weeks declined from 0·97 to 0·70 per 1000 births from 2004 to 2015, a reduction of 25% (RR 0·75, 95% CI 0·65-0·85). The pooled stillbirth rate at 22 weeks to less than 24 weeks of gestation in 2015 was 0·53 per 1000 births and did not significantly changed over time (RR 0·97, 95% CI 0·80-1·16) although changes varied widely between countries (RRs 0·62-2·09). Wide variation in the percentage of all births occurring at 22 weeks to less than 24 weeks of gestation suggest international differences in ascertainment. INTERPRETATION Present definitions used for international comparisons exclude a third of stillbirths. International consistency of reporting stillbirths at 24 weeks to less than 28 weeks suggests these deaths should be included in routinely reported comparisons. This addition would have a major impact, acknowledging the burden of perinatal death to families, and making international assessments more informative for clinical practice and policy. Ascertainment of fetal deaths at 22 weeks to less than 24 weeks should be stabilised so that all stillbirths from 22 completed weeks of gestation onwards can be reliably compared. FUNDING EU Union under the framework of the Health Programme and the Bridge Health Project.
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Affiliation(s)
- Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, UK.
| | - Ashna D Hindori-Mohangoo
- Netherlands Organisation for Applied Scientific Research, TNO Healthy Living, Department Child Health, Leiden, Netherlands; Perinatal Interventions Suriname, Perisur Foundation, Paramaribo, Suriname; Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Marie Delnord
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Mélanie Durox
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland
| | - Alison Macfarlane
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Sophie Alexander
- Perinatal Epidemiology and Reproductive Health Unit, ULB, Brussels, Belgium
| | | | - Mika Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland; Karolinska Institute, Stockholm, Sweden
| | - Béatrice Blondel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
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Ananth CV, Friedman AM, Goldenberg RL, Wright JD, Vintzileos AM. Association Between Temporal Changes in Neonatal Mortality and Spontaneous and Clinician-Initiated Deliveries in the United States, 2006-2013. JAMA Pediatr 2018; 172:949-957. [PMID: 30105352 PMCID: PMC6233764 DOI: 10.1001/jamapediatrics.2018.1792] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Preterm and postterm deliveries have declined since 2005 in the United States, but the association between these changes and neonatal mortality remains unknown. OBJECTIVE To estimate changes in the gestational age distribution among spontaneous and clinician-initiated deliveries between 2006 and 2013 and associated changes in neonatal mortality. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort analysis was conducted of 22 million singleton live births without major malformations in the United States from 2006 to 2013. Data analysis was performed from August to October 2017. MAIN OUTCOMES AND MEASURES Changes in gestational age distribution among spontaneous and clinician-initiated deliveries at extremely preterm (20-27 weeks), very preterm (28-31 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), early term (37-38 weeks), term (39-40), late term (41 weeks), and postterm (42-44 weeks) gestations and changes in neonatal mortality rates at less than 28 days between 2006 and 2013. These changes were estimated from log-linear Poisson regression models with robust variance, adjusted for confounders. RESULTS Among 22 million births, 12 493 531 (56.7%) were spontaneous and 9 557 815 (43.3%) were clinician-initiated deliveries. Among spontaneous deliveries, the proportion of births at 20 to 27, 28 to 31, 32 to 33, 34 to 36, and 37 to 38 weeks declined. Among clinician-initiated deliveries, the proportion of births at 34 to 36 and 37 to 38 weeks declined and the proportion at 39 to 40 weeks increased. Among spontaneous deliveries, overall neonatal mortality rates declined from 1.8 to 1.3 per 1000 live births, mainly at 20 to 27 weeks (adjusted annual decline, 1%; 95% CI, -2% to -1%) and 28 to 31 weeks (adjusted annual decline, 6%; 95% CI, -8% to -5%). Among clinician-initiated deliveries, overall mortality rates remained unchanged (2.1 to 2.2 per 1000 live births). However, mortality rates declined (0.6 to 0.5 per 1000 live births) at 39 to 40 weeks by 1% (95% CI, -3% to -0.4%) annually, adjusted for confounders. CONCLUSIONS AND RELEVANCE In the United States, there was a decline in spontaneous deliveries associated with an overall decline in neonatal mortality. Although clinician-initiated deliveries increased at 39 to 40 weeks, neonatal mortality at that gestation declined.
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Affiliation(s)
- Cande V. Ananth
- Department of Health Policy and Management, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
| | - Alexander M. Friedman
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jason D. Wright
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Anthony M. Vintzileos
- Department of Obstetrics and Gynecology, Winthrop Hospital, New York University, Mineola
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Smith LK, Morisaki N, Morken NH, Gissler M, Deb-Rinker P, Rouleau J, Hakansson S, Kramer MR, Kramer MS. An International Comparison of Death Classification at 22 to 25 Weeks' Gestational Age. Pediatrics 2018; 142:peds.2017-3324. [PMID: 29899042 DOI: 10.1542/peds.2017-3324] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To explore international differences in the classification of births at extremely low gestation and the subsequent impact on the calculation of survival rates. METHODS We used national data on births at 22 to 25 weeks' gestation from the United States (2014; n = 11 144), Canada (2009-2014; n = 5668), the United Kingdom (2014-2015; n = 2992), Norway (2010-2014; n = 409), Finland (2010-2015; n = 348), Sweden (2011-2014; n = 489), and Japan (2014-2015; n = 2288) to compare neonatal survival rates using different denominators: all births, births alive at the onset of labor, live births, live births surviving to 1 hour, and live births surviving to 24 hours. RESULTS For births at 22 weeks' gestation, neonatal survival rates for which we used live births as the denominator varied from 3.7% to 56.7% among the 7 countries. This variation decreased when the denominator was changed to include stillbirths (ie, all births [1.8%-22.3%] and fetuses alive at the onset of labor [3.7%-38.2%]) or exclude early deaths and limited to births surviving at least 12 hours (50.0%-77.8%). Similar trends were seen for infants born at 23 weeks' gestation. Variation diminished considerably at 24 and 25 weeks' gestation. CONCLUSIONS International variation in neonatal survival rates at 22 to 23 weeks' gestation diminished considerably when including stillbirths in the denominator, revealing the variation arises in part from differences in the proportion of births reported as live births, which itself is closely connected to the provision of active care.
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Affiliation(s)
- Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Naho Morisaki
- National Center for Child Health and Development, Tokyo, Japan;
| | - Nils-Halvdan Morken
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | - Michael R Kramer
- Department of Epidemiology, Emory University, Atlanta, Georgia; and
| | - Michael S Kramer
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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Ananth CV, Goldenberg RL, Friedman AM, Vintzileos AM. Association of Temporal Changes in Gestational Age With Perinatal Mortality in the United States, 2007-2015. JAMA Pediatr 2018; 172:627-634. [PMID: 29799945 PMCID: PMC6137502 DOI: 10.1001/jamapediatrics.2018.0249] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/24/2018] [Indexed: 11/14/2022]
Abstract
Importance Whether the changing gestational age distribution in the United States since 2005 has affected perinatal mortality remains unknown. Objective To examine changes in gestational age distribution and gestational age-specific perinatal mortality. Design, Setting, and Participants This retrospective cohort study examined trends in US perinatal mortality by linking live birth and infant death data among more than 35 million singleton births from January 1, 2007, through December 31, 2015. Exposures Year of birth and changes in gestational age distribution. Main Outcomes and Measures Changes in the proportion of births at gestational ages 20 to 27, 28 to 31, 32 to 33, 34 to 36, 37 to 38, 39 to 40, 41, and 42 to 44 weeks; changes in perinatal mortality (stillbirth at ≥20 weeks, and neonatal deaths at <28 days) rates; and contribution of gestational age changes to perinatal mortality. Trends were estimated from log-linear regression models adjusted for confounders. Results Among the 34 236 577 singleton live births during the study period, the proportion of births at all gestational ages declined, except at 39 to 40 weeks, which increased (54.5% in 2007 to 60.2% in 2015). Overall perinatal mortality declined from 9.0 to 8.6 per 1000 births (P < .001). Stillbirths declined from 5.7 to 5.6 per 1000 births (P < .001), and neonatal mortality declined from 3.3 to 3.0 per 1000 births (P < .001). Although the proportion of births at gestational ages 34 to 36, 37 to 38, and 42 to 44 weeks declined, perinatal mortality rates at these gestational ages showed annual adjusted relative increases of 1.0% (95% CI, 0.6%-1.4%), 2.3% (95% CI, 1.9%-2.8%), and 4.2% (95% CI, 1.5%-7.0%), respectively. Neonatal mortality rates at gestational ages 34 to 36 and 37 to 38 weeks showed a relative adjusted annual increase of 0.9% (95% CI, 0.2%-1.6%) and 3.1% (95% CI, 2.1%-4.1%), respectively. Although the proportion of births at gestational age 39 to 40 weeks increased, perinatal mortality showed an annual relative adjusted decline of -1.3% (95% CI, -1.8% to -0.9%). The decline in neonatal mortality rate was largely attributable to changes in the gestational age distribution than to gestational age-specific mortality. Conclusions and Relevance Although the proportion of births at gestational age 39 to 40 weeks increased, perinatal mortality at this gestational age declined. This finding may be owing to pregnancies delivered at 39 to 40 weeks that previously would have been unnecessarily delivered earlier, leaving fetuses at higher risk for mortality at other gestational ages.
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Affiliation(s)
- Cande V. Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Health Policy and Management, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alexander M. Friedman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Anthony M. Vintzileos
- Department of Obstetrics and Gynecology, New York University–Winthrop University Hospital, Mineola
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Liang FW, Chou HC, Chiou ST, Chen LH, Wu MH, Lue HC, Chiang TL, Lu TH. Trends in birth weight-specific and -adjusted infant mortality rates in Taiwan between 2004 and 2011. Pediatr Neonatol 2018; 59:267-273. [PMID: 28965850 DOI: 10.1016/j.pedneo.2017.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 07/24/2017] [Accepted: 08/31/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A yearly increase in the proportion of very low birth weight (VLBW) live births has resulted in the slowdown of decreasing trends in crude infant mortality rates (IMRs). In this study, we examined the trends in birth weight-specific as well as birth weight-adjusted IMRs in Taiwan. METHODS We linked three nationwide datasets, namely the National Birth Reporting Database, National Birth Certification Registry, and National Death Certification Registry databases, to calculate the IMRs according to the birth weight category. Trend tests and mortality rate ratios in the periods 2010-2011 and 2004-2005 were used to examine the extent of reduction in birth weight-specific and birth weight-adjusted IMRs. RESULTS The proportion of VLBW (<1500 g) infants among live births increased from 0.78% in 2004-2005 to 0.89% in 2010-2011, thus exhibiting a 15% increase. The extents of the decreases in birth weight-specific IMRs in the 500-999, 1000-1499, 1500-1999, 2000-2499, and 2500-2999 g birth weight categories were 15%, 33%, 43%, 30%, and 28%, respectively, from 2004-2005 to 2010-2011. The reduction in IMR in each birth weight category was larger than the reduction in the crude IMR (13%). By contrast, the IMR in the <500 g birth weight category exhibited a 56% increase during the study period. The IMRs were calculated by excluding all live births with a birth weight of <500 g. The birth weight-adjusted IMRs, which were calculated using a standard birth weight distribution structure for adjustment, exhibited similar extent reductions. CONCLUSION In countries with an increasing proportion of VLBW live births, birth weight-specific or -adjusted IMRs are more appropriate than other indices for accurately assessing the real extent of reduction in IMRs.
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Affiliation(s)
- Fu-Wen Liang
- NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Ti Chiou
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan; National Yang-Ming University, Institute of Public Health, Taiwan; Taoyuan General Hospital, Ministry of Health and Welfare, Taiwan
| | - Li-Hua Chen
- Department of Statistics, Ministry of Health and Welfare, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Tung-Liang Chiang
- Institute of Health Policy and Management, School of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Zylbersztejn A, Gilbert R, Hjern A, Wijlaars L, Hardelid P. Child mortality in England compared with Sweden: a birth cohort study. Lancet 2018; 391:2008-2018. [PMID: 29731173 PMCID: PMC5958228 DOI: 10.1016/s0140-6736(18)30670-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 02/27/2018] [Accepted: 03/09/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Child mortality is almost twice as high in England compared with Sweden. We aimed to establish the extent to which adverse birth characteristics and socioeconomic factors explain this difference. METHODS We developed nationally representative cohorts of singleton livebirths between Jan 1, 2003, and Dec 31, 2012, using the Hospital Episode Statistics in England, and the Swedish Medical Birth Register in Sweden, with longitudinal follow-up from linked hospital admissions and mortality records. We analysed mortality as the outcome, based on deaths from any cause at age 2-27 days, 28-364 days, and 1-4 years. We fitted Cox proportional hazard regression models to estimate the hazard ratios (HRs) for England compared with Sweden in all three age groups. The models were adjusted for birth characteristics (gestational age, birthweight, sex, and congenital anomalies), and for socioeconomic factors (maternal age and socioeconomic status). FINDINGS The English cohort comprised 3 932 886 births and 11 392 deaths and the Swedish cohort comprised 1 013 360 births and 1927 deaths. The unadjusted HRs for England compared with Sweden were 1·66 (95% CI 1·53-1·81) at 2-27 days, 1·59 (1·47-1·71) at 28-364 days, and 1·27 (1·15-1·40) at 1-4 years. At 2-27 days, 77% of the excess risk of death in England was explained by birth characteristics and a further 3% by socioeconomic factors. At 28-364 days, 68% of the excess risk of death in England was explained by birth characteristics and a further 11% by socioeconomic factors. At 1-4 years, the adjusted HR did not indicate a significant difference between countries. INTERPRETATION Excess child mortality in England compared with Sweden was largely explained by the unfavourable distribution of birth characteristics in England. Socioeconomic factors contributed to these differences through associations with adverse birth characteristics and increased mortality after 1 month of age. Policies to reduce child mortality in England could have most impact by reducing adverse birth characteristics through improving the health of women before and during pregnancy and reducing socioeconomic disadvantage. FUNDING The Farr Institute of Health Informatics Research (through the Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institute for Social Care and Health Research, and the Wellcome Trust).
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Affiliation(s)
- Ania Zylbersztejn
- The Farr Institute of Health Informatics Research, London, UK; Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Ruth Gilbert
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK; Children's Policy Research Unit, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Anders Hjern
- Centre for Health Equity Studies (CHESS), Stockholm University, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Linda Wijlaars
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Pia Hardelid
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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Smith LK, Matthews RJ, Field DJ. Decision-making at the limits of viability: recognising the influence of parental factors. Arch Dis Child Fetal Neonatal Ed 2018; 103:F196-F197. [PMID: 29074719 DOI: 10.1136/archdischild-2017-313702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Lucy K Smith
- The Infant Mortality and Morbidity Studies, Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester, UK
| | - Ruth J Matthews
- The Infant Mortality and Morbidity Studies, Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester, UK
| | - David J Field
- The Infant Mortality and Morbidity Studies, Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester, UK
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Lehner C, Harry A, Pelecanos A, Wilson L, Pink K, Sekar R. The feasibility of a clinical audit tool to investigate stillbirth in Australia - a single centre experience. Aust N Z J Obstet Gynaecol 2018; 59:59-65. [DOI: 10.1111/ajo.12799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 02/15/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Christoph Lehner
- Centre for Advanced Prenatal Care; The Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Amanda Harry
- Obstetrics and Gynaecology; The Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute; Brisbane Australia
| | - Lauren Wilson
- Obstetrics and Gynaecology; The Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Kate Pink
- Obstetrics and Gynaecology; The Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Renuka Sekar
- Centre for Advanced Prenatal Care; The Royal Brisbane and Women's Hospital; Brisbane Australia
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Zylbersztejn A, Gilbert R, Hjern A, Hardelid P. How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy? BMC Pregnancy Childbirth 2017; 17:430. [PMID: 29258452 PMCID: PMC5738161 DOI: 10.1186/s12884-017-1622-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 12/07/2017] [Indexed: 11/16/2022] Open
Abstract
Background Infant mortality rates are commonly used to compare the health of populations. Observed differences are often attributed to variation in child health care quality. However, any differences are at least partly explained by variation in the prevalence of risk factors at birth, such as low birth weight. This distinction is important for designing interventions to reduce infant mortality. We suggest a simple method for decomposing inter-country differences in crude infant mortality rates into two metrics representing risk factors operating before and after birth. Methods We used data from 7 European countries participating in the EURO-PERISTAT project in 2010. We calculated crude and birth weight-standardised stillbirth and infant mortality rates using Norway as the standard population. We decomposed between-country differences in crude stillbirth and infant mortality rates into the within-country difference in crude and birth weight-standardised stillbirth and infant mortality rates (metric 1), reflecting prenatal risk factors, and the between-country difference in birth weight-standardised stillbirth and infant mortality rates (metric 2), reflecting risk factors operating after birth. We also calculated birth weight-specific mortality. Results Using our metrics, we showed that for England, Wales and Scotland risk factors before and after birth contributed equally to the differences in crude stillbirth and infant mortality rates relative to Norway. In Austria, Czech Republic and Switzerland the differences were driven primarily by metric 1, reflecting high rate of low birth weight. The highest values of metric 2 observed in Poland partially reflected high rates of congenital anomalies. Conclusions Our suggested metrics can be used to guide policy decisions on preventing infant deaths through reducing risk factors at birth or improving the care of babies after birth. Aggregate data tabulated by birth weight/gestational age should be routinely collected and published in high-income countries where birth weight is reported on birth certificates. Electronic supplementary material The online version of this article (10.1186/s12884-017-1622-z) contains supplementary material, which is available to authorized users.
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Smith LK. Ensuring the Comparability of Infant Mortality Rates: the Impact of the Management of Pre-Viable and Peri-Viable Births. Paediatr Perinat Epidemiol 2017; 31:392-393. [PMID: 28686289 DOI: 10.1111/ppe.12381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lucy K Smith
- Department of Health Sciences, The Infant Mortality and Morbidity Studies, University of Leicester, Leicester, UK
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Joseph KS, Razaz N, Muraca GM, Lisonkova S. Methodological Challenges in International Comparisons of Perinatal Mortality. CURR EPIDEMIOL REP 2017; 4:73-82. [PMID: 28680794 PMCID: PMC5488116 DOI: 10.1007/s40471-017-0101-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Several prestigious agencies routinely rank countries based on crude perinatal and infant mortality rates, while more recently, international neonatal networks have begun comparing neonatal mortality and morbidity rates among very preterm and very low-birth-weight infants. We discuss the methodologic challenges that compromise such comparisons and potential remedies. RECENT FINDINGS Crude perinatal mortality rates are biased by international variations in birth registration, especially at the borderline of viability. Such bias is demonstrated by significant differences in crude versus birth weight- and gestational age-specific comparisons of perinatal mortality. Comparisons of neonatal mortality among very preterm and very low-birth-weight infants are plagued by incorrect denominators, and this leads to paradoxical findings. SUMMARY A lack of standardization with regard to birth registration and inadequate appreciation of the methods for calculating gestational age-specific mortality rates are responsible for biasing international comparisons of perinatal mortality.
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Affiliation(s)
- K. S. Joseph
- Department of Obstetrics and Gynaecology and the School of Population and Public Health, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Room C403, Women’s Hospital of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Neda Razaz
- Reproductive Epidemiology Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giulia M. Muraca
- Department of Obstetrics and Gynaecology and the School of Population and Public Health, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Room C403, Women’s Hospital of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology and the School of Population and Public Health, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Room C403, Women’s Hospital of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
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Kelly LE, Shah PS, Håkansson S, Kusuda S, Adams M, Lee SK, Sjörs G, Vento M, Rusconi F, Lehtonen L, Reichman B, Darlow BA, Lui K, Feliciano LS, Gagliardi L, Bassler D, Modi N. Perinatal health services organization for preterm births: a multinational comparison. J Perinatol 2017; 37:762-768. [PMID: 28383541 DOI: 10.1038/jp.2017.45] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore population characteristics, organization of health services and comparability of available information for very low birth weight or very preterm neonates born before 32 weeks' gestation in 11 high-income countries contributing data to the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN We obtained population characteristics from public domain sources, conducted a survey of organization of maternal and neonatal health services and evaluated the comparability of data contributed to the iNeo collaboration from Australia, Canada, Finland, Israel, Italy, Japan, New Zealand, Spain, Sweden, Switzerland and UK. RESULTS All countries have nationally funded maternal/neonatal health care with >90% of women receiving prenatal care. Preterm birth rate, maternal age, and neonatal and infant mortality rates were relatively similar across countries. Most (50 to >95%) between-hospital transports of neonates born at non-tertiary units were conducted by designated transport teams; 72% (8/11 countries) had designated transfer and 63% (7/11 countries) mandate the presence of a physician. The capacity of 'step-down' units varied between countries, with capacity for respiratory care available in <10% to >75% of units. Heterogeneity in data collection processes for benchmarking and quality improvement activities were identified. CONCLUSIONS Comparability of healthcare outcomes for very preterm low birth weight neonates between countries requires an evaluation of differences in population coverage, healthcare services and meta-data.
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Affiliation(s)
- L E Kelly
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada
| | - P S Shah
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, Canada
| | - S Håkansson
- Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - S Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - M Adams
- Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Switzerland, Switzerland
| | - S K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, Canada
| | - G Sjörs
- Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - M Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - F Rusconi
- Unit of Epidemiology, TIN Toscane Online, Meyer Children's University Hospital, Regional Health Agency, Florence, Italy
| | - L Lehtonen
- Department of Pediatrics, Finnish Medical Birth Register and Register of Congenital Malformations, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, Finland
| | - B Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - B A Darlow
- Department of Paediatrics, Australia and New Zealand Neonatal Network, University of Otago, Christchurch, New Zealand
| | - K Lui
- National Perinatal Epidemiology and Statistic Unit, Australian and New Zealand Neonatal Network, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia
| | - L S Feliciano
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - L Gagliardi
- Division of Pediatrics and Neonatology, Ospedale Versilia, Viareggio, Italy
| | - D Bassler
- Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Switzerland, Switzerland
| | - N Modi
- Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, UK Neonatal Collaborative, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
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Ananth CV, Chauhan SP. Epidemiology of Periviable Births: The Impact and Neonatal Outcomes of Twin Pregnancy. Clin Perinatol 2017; 44:333-345. [PMID: 28477664 DOI: 10.1016/j.clp.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article discusses a study that estimated the prevalence of twin live births in the United States that were delivered in the periviable (20-25 weeks) gestational age, and compared changes in twin neonatal mortality and morbidity rates between 2005 and 2013 overall, and at periviable gestations. Although the decline in twin neonatal mortality rates at 23 and 24 weeks is encouraging, and suggests advancement in the neonatal care of these extremely small twins, the concomitant increase in neonatal morbidity at 23 weeks is concerning. Efforts to understand if twins delivered at periviable gestations suffer from long-term consequences of neurodevelopmental and cognitive deficits remain important.
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Affiliation(s)
- Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, 622 West 168 Street, New York, NY 10032, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, 722 West 168 Street, New York, NY 10032, USA.
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas, 6432 Fannin Street, MSB 3.286, Houston, TX 77030, USA
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Morisaki N, Ganchimeg T, Vogel JP, Zeitlin J, Cecatti JG, Souza JP, Pileggi Castro C, Torloni MR, Ota E, Mori R, Dolan SM, Tough S, Mittal S, Bataglia V, Yadamsuren B, Kramer MS. Impact of stillbirths on international comparisons of preterm birth rates: a secondary analysis of the WHO multi-country survey of Maternal and Newborn Health. BJOG 2017; 124:1346-1354. [PMID: 28220656 PMCID: PMC5573985 DOI: 10.1111/1471-0528.14548] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the extent to which stillbirths affect international comparisons of preterm birth rates in low‐ and middle‐income countries. Design Secondary analysis of a multi‐country cross‐sectional study. Setting 29 countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Population 258 215 singleton deliveries in 286 hospitals. Methods We describe how inclusion or exclusion of stillbirth affect rates of preterm births in 29 countries. Main outcome measures Preterm delivery. Results In all countries, preterm birth rates were substantially lower when based on live births only, than when based on total births. However, the increase in preterm birth rates with inclusion of stillbirths was substantially higher in low Human Development Index (HDI) countries [median 18.2%, interquartile range (17.2–34.6%)] compared with medium (4.3%, 3.0–6.7%), and high‐HDI countries (4.8%, 4.4–5.5%). Conclusion Inclusion of stillbirths leads to higher estimates of preterm birth rate in all countries, with a disproportionately large effect in low‐HDI countries. Preterm birth rates based on live births alone do not accurately reflect international disparities in perinatal health; thus improved registration and reporting of stillbirths are necessary. Tweetable abstract Inclusion of stillbirths increases preterm birth rates estimates, especially in low‐HDI countries. Inclusion of stillbirths increases preterm birth rates estimates, especially in low‐HDI countries.
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Affiliation(s)
- N Morisaki
- Department of Social Medicine, National Center for Child Health and Research, Tokyo, Japan
| | - T Ganchimeg
- Department of Global Health Nursing, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - J P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - J Zeitlin
- Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - J G Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - J P Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - C Pileggi Castro
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - M R Torloni
- Evidence Based Healthcare Post-graduate Program, Sao Paulo Federal University, Sao Paulo, Brazil
| | - E Ota
- Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - R Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - S M Dolan
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
| | - S Tough
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S Mittal
- Department of Obstetrics & Gynecology, Fortis Memorial Research Institute, Gurgaon, India
| | - V Bataglia
- Department of Gynaecology, Obstetrics and Perinatology Central Hospital, Social Security Institute, Asuncion, Paraguay
| | - B Yadamsuren
- National Center for Communicable Diseases, Ulaanbaatar, Mongolia
| | - M S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, Canada
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Level, Causes and Risk Factors of Neonatal Mortality, in Jordan: Results of a National Prospective Study. Matern Child Health J 2017; 20:1061-71. [PMID: 26645614 DOI: 10.1007/s10995-015-1892-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The present study aimed at assessment of the magnitude of neonatal mortality in Jordan, and its causes and associated factors. METHODS Through a multistage sampling technique, a total of 21,928 deliveries with a gestational period ≥20 weeks from 18 hospitals were included in the study. The status of their babies 28 days after birth, whether dead or alive, was ascertained. Extensive data were collected about mothers and their newborns at admission and after 28 days of birth. Causes of death were classified according to the neonatal and intrauterine death classification according to etiology. Preventability of death was classified according to Herman's classification into preventable, partially preventable, and not preventable. RESULTS Neonatal mortality rate, overall and for subgroups of the study was obtained. Risk factors for neonatal mortality were first examined in bivariate analyses and finally by multivariate logistic regression models to account for potential confounders. A total of 327 babies ≥20 weeks of gestation died in the neonatal period (14.9/1000 LB). Excluding babies <1000 g and <28 weeks of gestation to be consistent with the WHO and UNICEF's annual neonatal mortality reports, the NNMR decreased to 10.5/1000 LB. About 79 % of all neonatal deaths occurred in the first week after birth with over 42 % occurring in the first day after birth. According to NICE hierarchical classification, most neonatal deaths were due to congenital anomalies (27.2 %), multiple births (26.0 %), or unexplained immaturity (21.7 %). Other important causes included maternal disease (6.7 %), specific infant conditions (6.4 %), and unexplained asphyxia (4.9 %). According to Herman's classification, 37 % of neonatal deaths were preventable and 59 % possibly preventable. An experts' panel determined that 37.3 % of neonatal deaths received optimal medical care while the medical care provided to the rest was less than optimal. After adjusting for socio-demographic characteristics, type of the hospital, and clinical and medical history of women, the following variables were significantly associated with neonatal mortality: male gender, congenital defects, inadequate antenatal visits, multiple pregnancy, presentation at delivery, and gestational age. CONCLUSION The present study showed the level, causes, and risk factors of NNM in Jordan. It showed also that a large proportion of NNDs are preventable or possibly preventable. Providing optimal intrapartum, and immediate postpartum care is likely to result in avoidance of a large proportion of NNDs.
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Biodemographic Analysis of Factors Related to Perinatal Mortality in Portugal (1988-2011). Int J Pediatr 2016; 2016:6123065. [PMID: 27867399 PMCID: PMC5102729 DOI: 10.1155/2016/6123065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/27/2016] [Accepted: 09/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background. The purpose of this paper is to determine the relative mortality risks at delivery and during the first week of life with regard to maternal and foetal characteristics. Methods. Yearly individual digital records on live births and early neonatal mortality were used to infer the possible factors involved in perinatal deaths. Results. The results show that the number of births per year declined with time throughout the period studied. At the same time, rates decreased in 66.4% for stillbirths and in 70.2% for early neonatal mortality. Logistic regressions modelled the interaction of the two mortality indicators and covariables such as birth weight and the duration of gestation. Conclusions. This research provides a first biodemographic approach to the knowledge of factors influencing perinatal mortality in Portugal based on a set of foetal and maternal variables. Although the magnitude of the different perinatal mortality rates may be affected by the criteria used for selecting cases (multiple-singletons; minimum birth weight or minimum duration of gestation), one of the conclusions of the present analysis is that the relationship among the maternal and foetal variables that determine the relative risk remains unaltered. Certain resemblance with the factors determining negative birth outcomes in Spain is appreciated.
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Infant mortality in the United States. J Perinatol 2016; 36:797-801. [PMID: 27101388 DOI: 10.1038/jp.2016.63] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/15/2016] [Accepted: 03/09/2016] [Indexed: 11/08/2022]
Abstract
The infant mortality rate (IMR) of 6.0 per 1000 live births in the United States in 2013 is nearly the highest among developed countries. Moreover, the IMR among blacks is >twice that among whites-11.11 versus 5.06 deaths per 1000 live births.This higher IMR and racial disparity in IMR is due to a higher preterm birth rate (11.4% of live births in 2013) and higher IMR among term infants. The United States also ranks near the bottom for maternal mortality and life expectancy among the developed nations-despite ranking highest in the proportion of gross national product spent on health care. This suggests that factors other than health care contribute to the higher IMR and racial disparity in IMR. One factor is disadvantaged socioeconomic status. All of the actionable determinates that negatively impact health-personal behavior, social factors, heath-care access and quality and the environment-disproportionately affect the poor. Addressing disadvantaged socioeconomic status by improving access to quality health care and increasing social expenditures would have the greatest impact on the USA's IMR and racial disparity in IMR.
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