Klitkou Søren T, Iversen Tor, Stensvold Hans J, Rønnestad Arild
Department of Health Management and Health Economics, University of Oslo, P.b. 1089 Blindern, NO 0317, Oslo, Norway.
Clinic for Pediatric and Adolescent Medicine, Neonatal Intensive Care Unit, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
BMC Health Serv Res. 2017 Aug 17;17(1):571. doi: 10.1186/s12913-017-2498-3.
Very preterm (VPT) children, with a birth weight below 1500 g or delivered before 32 weeks of gestational age, are at increased risk of poorer long-term health outcomes and higher rates of hospitalization in childhood. However, considerable variation exists in the need for in-hospital care within this population. We assessed the utilization and distribution of hospital-based care from ages 1 through 9 years for a nationwide population.
This was a population-based cohort of VPT children born in the period 2001-2009. We evaluated their utilization of hospital care in 2008-2010, when aged 1-9 years old. Outcomes were the incidence of hospital admissions and outpatient visits. We used Poisson regression models with multiple imputation of missing data.
Children born VPT had more hospital admissions compared with the general population of children aged 1-9 years. The rates of hospital admissions and outpatient visits were strongly related to clinical characteristics of the child at birth and age at admission/outpatient visit but to only a variable and minor degree to characteristics pertaining to maternal health, the sociodemographic factors, and geographical proximity to hospital services.
Prior to this study, hospital utilization during the period 5-9 years old has been poorly documented. We found that excess utilization of hospital resources on average declines with increasing age. We also noted substantial differences in the use of hospital care across age groups and clinical factors for VPT children. The added information from the health status of mothers, social background, and geographic measures of access was limited.
极早产儿（VPT）是指出生体重低于1500克或胎龄在32周前出生的婴儿，他们长期健康状况较差以及儿童期住院率较高的风险增加。然而，这一群体的住院护理需求存在很大差异。我们评估了全国范围内1至9岁儿童基于医院护理的利用情况和分布。
这是一项基于人群的队列研究，研究对象为2001年至2009年期间出生的极早产儿。我们评估了他们在2008年至2010年（年龄为1至9岁）期间的医院护理利用情况。结果指标为住院和门诊就诊的发生率。我们使用了对缺失数据进行多重插补的泊松回归模型。
与1至9岁儿童的总体人群相比，极早产儿出生的儿童住院次数更多。住院和门诊就诊率与儿童出生时的临床特征以及住院/门诊就诊时的年龄密切相关，但与母亲健康状况、社会人口统计学因素以及与医院服务的地理距离等特征仅存在可变且较小程度的关联。
在本研究之前，5至9岁期间的医院利用情况记录不佳。我们发现，医院资源的过度利用平均随着年龄增长而下降。我们还注意到，极早产儿在不同年龄组和临床因素方面的医院护理使用存在很大差异。来自母亲健康状况、社会背景和地理可及性措施的额外信息有限。
