Ravelli Anita C J, Rijninks-van Driel Greta C, Erwich Jan Jaap H M, Mol Ben Willem J, Brouwers Hens A A, Abu Hanna Ameen, Eskes Martine
Academisch Medisch Centrum, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2011;155:A2689.
To investigate differences in perinatal mortality between Dutch provinces and to determine the significance of risk factors including travel time from home to the hospital during labour.
Cohort study.
The study was based on 1,242,725 singleton births in 2000-2006 as recorded in the Netherlands Perinatal Registry. The influence of province on perinatal mortality was estimated, with logistic regression analysis adjusting for risk factors (age, parity, ethnicity, socioeconomic status) and care factors such as start of antenatal care and travel time.
The perinatal mortality rate in the Netherlands was 9.9 per 1000 births. The provinces with the highest mortality rates were Friesland (11.3‰), Groningen (11.1‰), Zeeland (10.6‰) and Flevoland (10.4‰). Noord-Brabant (9.2‰) and Limburg (9.2‰) had the lowest mortality rates. These differences were significantly higher for Friesland (odds ratio: 1.16; 95%-CI: 1.05-1.28) and Groningen (odds ratio: 1.13; 95%-CI: 1.02-1.26). Starting late with perinatal care, at 18 weeks of gestation or later was an important risk factor (adjusted odds ratio 1.8; 95%-CI: 1.7-1.8). Low socio-economic status could partly be associated with the higher mortality risk in Groningen. Longer travel time (≥ 20 minutes) was an independent risk factor associated with perinatal mortality. On average 19% of the women travelled ≥ 20 minutes to the hospital. In the provinces Groningen, Friesland, Flevoland and Zeeland these percentages ranged between 32 and 36%. The adjusted odds ratio of travel time was 1.7 (95%-CI 1.6-1.7).
The perinatal mortality differs per province. This can be explained by longer travel time to the hospital during labour. Late start of perinatal care and low socio-economic status also affect the mortality rate. These risk factors need to be taken into account during registration, investigation, audit and obstetric policy.
调查荷兰各省围产期死亡率的差异，并确定包括分娩时从家到医院的行程时间等风险因素的重要性。
队列研究。
该研究基于荷兰围产期登记处记录的2000 - 2006年期间1,242,725例单胎分娩。通过逻辑回归分析估计省份对围产期死亡率的影响，并对风险因素（年龄、产次、种族、社会经济地位）和护理因素（如产前护理开始时间和行程时间）进行调整。
荷兰的围产期死亡率为每1000例分娩9.9例。死亡率最高的省份是弗里斯兰省（11.3‰）、格罗宁根省（11.1‰）、泽兰省（10.6‰）和弗莱福兰省（(10.4‰)。北布拉班特省（9.2‰）和林堡省（9.2‰）死亡率最低。弗里斯兰省（优势比：1.16；95%置信区间：1.05 - 1.28）和格罗宁根省（优势比：1.13；95%置信区间：1.02 - 1.26）的这些差异显著更高。围产期护理开始较晚，即在妊娠18周或更晚开始是一个重要的风险因素（调整后的优势比为1.8；95%置信区间：1.7 - 1.8）。社会经济地位低可能部分与格罗宁根省较高的死亡风险相关。较长的行程时间（≥20分钟）是与围产期死亡率相关的独立风险因素。平均19%的女性前往医院的行程时间≥20分钟。在格罗宁根省、弗里斯兰省、弗莱福兰省和泽兰省，这些百分比在32%至36%之间。行程时间的调整后优势比为1.7（95%置信区间1.6 - 1.7）。
各省的围产期死亡率不同。这可以通过分娩时前往医院的行程时间较长来解释。围产期护理开始较晚和社会经济地位低也会影响死亡率。在登记、调查、审计和产科政策制定过程中需要考虑这些风险因素。
