Disentangling the effects of risk factors and clinical care on subnational variation in early neonatal mortality in the United States

Between 1990 and 2010, the U.S ranking in neonatal mortality slipped from 29(th) to 45(th) among countries globally. Substantial subnational variation in newborn mortality also exists. Our objective is to measure the extent to which trends and subnational variation in early neonatal mortality reflec...

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Bibliographic Details
Published in:PloS one 2012-11, Vol.7 (11), p.e49399-e49399
Main Authors: Straney, Lahn D, Lim, Stephen S, Murray, Christopher J L
Format: Article
Language:English
Subjects:
Age
Babies
Biology
Birth weight
Birth Weight - physiology
Catchment Area, Health - statistics & numerical data
Childbirth & labor
Epidemiology
Gestational Age
Health aspects
Health services
Humans
Infant Care - statistics & numerical data
Infant mortality
Infant Mortality - trends
Infant, Newborn
Intensive care
Low birth weight
Medical research
Medicine
Models, Statistical
Mortality
Neonates
Newborn babies
Newborn infants
Observational studies
Pediatrics
Premature birth
Prevalence
Quality
Risk analysis
Risk Factors
Studies
Trends
United States - epidemiology
Variation
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Summary:Between 1990 and 2010, the U.S ranking in neonatal mortality slipped from 29(th) to 45(th) among countries globally. Substantial subnational variation in newborn mortality also exists. Our objective is to measure the extent to which trends and subnational variation in early neonatal mortality reflect differences in the prevalence of risk factors (gestational age and birth weight) compared to differences in clinical care. Observational study using linked birth and death data for all births in the United States between 1996 and 2006. We examined health service area (HSA) level variation in the expected early neonatal mortality rate, based on gestational age (GA) and birth-weight (BW), and GA-BW adjusted mortality as a proxy for clinical care. We analyzed the relationship between selected health system indicators and GA-BW-adjusted mortality. The early neonatal death (ENND) rate declined 12% between 1996 and 2006 (2.39 to 2.10 per 1000 live births). This occurred despite increases in risk factor prevalence. There was significant HSA-level variation in the expected ENND rate (Rate Ratio: 0.73-1.47) and the GA-BW adjusted rate (Rate ratio: 0.63-1.68). Accounting for preterm volume (defined as
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0049399