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

ABSTRACT:

Objective

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.

Methods

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

SUBMITTER: Straney LD 

PROVIDER: S-EPMC3498121 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature