Journal article
Neonatal complications in public and private patients: a retrospective cohort study
BMJ open, Vol.3(5), e002786
2013
PMCID: PMC3669710
PMID: 23793654
Abstract
Objective
To use propensity score methods to create similar groups of women delivering in public and private hospitals and determine any differences in mode of delivery and neonatal outcomes between the matched groups.
Design
Population-based, retrospective cohort study.
Setting
Public and private hospitals in Western Australia.
Participants
Included were 93 802 public and 66 479 private singleton, term deliveries during 1998–2008, from which 32 757 public patients were matched with 32 757 private patients on the propensity score of maternal characteristics.
Main outcome measures
Neonatal outcomes were compared in the propensity score-matched cohorts using conditional logistic regression, adjusted for antenatal risk factors and mode of delivery. Outcomes included Apgar score <7 at 5 min, neonatal resuscitation (endotracheal intubation or external cardiac massage) and admission to a neonatal special care unit.
Results
No significant differences in maternal characteristics were found between the propensity score-matched groups. Private patients were more likely than their matched public counterparts to undergo prelabour caesarean section (25.2% vs 18%, p<0.0001). Public patients had lower rates of neonatal unit admission (AOR 0.67, 95% CI 0.62 to 0.73) and neonatal resuscitation (AOR 0.73, 95% CI 0.56 to 0.95), but higher rates of low Apgar scores at 5 min (AOR 1.31, 95% CI 1.06 to 1.63) despite adjustment for antenatal factors. Additional adjustment for mode of delivery reduced the resuscitation risk (AOR 0.86, 95% CI 0.63 to 1.18) but did not significantly alter the other estimates.
Conclusions
Propensity score methods can be used to generate comparable groups of public and private patients. Despite the rates of low Apgar scores being higher in public patients, the rates of special care admission were lower. Whether these findings stem from differences in paediatric services or clinical factors is yet to be determined.
Details
- Title
- Neonatal complications in public and private patients: a retrospective cohort study
- Authors/Creators
- Kristjana Einarsdottir - The Kids Research Institute AustraliaSarah Stock - King Edward Memorial HospitalFatima Haggar - The University of Western AustraliaGeoffrey Hammond - The Kids Research Institute AustraliaAmanda T. Langridge - The Kids Research Institute AustraliaDavid B. Preen - The University of Western AustraliaNick De Klerk - Univ Western Australia, Ctr Child Hlth Res, Telethon Inst Child Hlth Res, Perth, WA 6009, AustraliaHelen Leonard - The Kids Research Institute AustraliaFiona J. Stanley - The Kids Research Institute Australia
- Publication Details
- BMJ open, Vol.3(5), e002786
- Publisher
- Bmj Publishing Group
- Number of pages
- 7
- Grant note
- G1002033 / Medical Research Council; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) G1002033 / MRC; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) 634 533; 573 122 / Australia's National Health and Medical Research Council; National Health and Medical Research Council (NHMRC) of Australia
- Identifiers
- 991005571160207891
- Murdoch Affiliation
- Ngangk Yira Institute for Change
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
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- Citation topics
- 1 Clinical & Life Sciences
- 1.72 Obstetrics & Gynecology
- 1.72.808 Childbirth Practices
- Web Of Science research areas
- Obstetrics & Gynecology
- ESI research areas
- Clinical Medicine