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. 2012 Apr;50(4):353-60.
doi: 10.1097/MLR.0b013e318245a128.

Evaluating the effect of hospital and insurance type on the risk of 1-year mortality of very low birth weight infants: controlling for selection bias

Songthip Ounpraseuth  1 , C Heath Gauss, Janet Bronstein, Curtis Lowery, Richard Nugent, Richard Hall
Affiliations

Evaluating the effect of hospital and insurance type on the risk of 1-year mortality of very low birth weight infants: controlling for selection bias

Songthip Ounpraseuth et al. Med Care. 2012 Apr.

Abstract

Objectives: We examined the effect of hospital type and medical coverage on the risk of 1-year mortality of very low birth weight (VLBW) infants while adjusting for possible selection bias.

Methods: The study population was limited to singleton live birth infants having birth weight between 500 and 1500 g with no congenital anomalies who were born in Arkansas hospitals between 2001 and 2007. Propensity score (PS) matching and PS covariate adjustment were used to mitigate selection bias. In addition, a conventional multivariable logistic regression model was used for comparison purposes.

Results: Generally, all 3 analytical approaches provided consistent results in terms of the estimated relative risk, absolute risk reduction, and the number needed to treat. Using the PS matching method, VLBW infants delivered at a hospital with a neonatal intensive care unit (NICU) were associated with a 35% relative decrease (95% bootstrap confidence interval, 18.5%-48.9%) in the risk of 1-year mortality as compared with those infants delivered at non-NICU hospitals. Furthermore, our results showed that on average, 16 VLBW infants (95% bootstrap confidence interval, 11-32), would need to be delivered at a hospital with an NICU to prevent 1 additional death at 1 year. However, there was not a difference in the risk of 1-year mortality between VLBW infants born to Medicaid-insured versus non-Medicaid-insured women.

Conclusions: Estimated relative risk of infant mortality was significantly lower for births that occurred in hospitals with an NICU; therefore, greater efforts should be made to deliver VLBW neonates in an NICU hospital.

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Figures

Figure 1
Figure 1
Distribution of propensity score in NICU/non-NICU infants
Figure 2
Figure 2
Standardized Differences Plots (a) Standardized Differences Using Propensity Score Matching, (b) Weighted Standardized Differences Using Propensity Score Regression Adjustment
Figure 3
Figure 3
Birth weight and gestational age-specific 1-year mortality probability controlling for the Medicaid white female combinations.
See this image and copyright information in PMC

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