Piper J M, Ray W A, Griffin M R, Fought R, Daughtery J R, Mitchel E
Department of Preventive Medicine, Vanderbilt University, Nashville, TN 37232.
Am J Epidemiol. 1990 Sep;132(3):561-71. doi: 10.1093/oxfordjournals.aje.a115692.
In a recent effort to lower the US infant mortality rate, Congress has expanded the Medicaid coverage options that states may offer pregnant women. Careful evaluation of changes in perinatal outcome associated with this expanded coverage is needed. The linkage of Medicaid enrollment files of mothers and infants to birth, death, and fetal death certificates is an initial step in assessing the effectiveness that Medicaid coverage expansions have had on pregnancy outcome. Creation of such a database for Tennessee for 1984-1987 revealed that complete information on mother, delivery, and child is available for only three quarters of Medicaid-reimbursed births. Furthermore, Medicaid-reimbursed births that had all three data components had different characteristics and lower mortality rates than did births with missing elements. Those persons seeking to evaluate expanded Medicaid coverage for pregnant women need to be aware that consideration of only those births for whom there is information on mother, delivery, and child may lead to serious underascertainment of fetal, perinatal, and neonatal mortality rates.
为了降低美国的婴儿死亡率，国会最近扩大了各州可为孕妇提供的医疗补助覆盖范围。有必要仔细评估与这种扩大覆盖范围相关的围产期结局变化。将母亲和婴儿的医疗补助登记档案与出生、死亡及胎儿死亡证明相联系，是评估医疗补助覆盖范围扩大对妊娠结局有效性的第一步。为田纳西州创建的1984 - 1987年此类数据库显示，在医疗补助报销的分娩中，仅有四分之三能获取母亲、分娩及孩子的完整信息。此外，具备所有三个数据组成部分的医疗补助报销分娩与缺少某些要素的分娩相比，具有不同特征且死亡率更低。那些试图评估扩大孕妇医疗补助覆盖范围的人需要意识到，仅考虑那些有母亲、分娩及孩子信息的分娩，可能会严重低估胎儿、围产期及新生儿死亡率。
