Laugier Olivia, Garcia Patricia, Boucékine Mohamed, Daguzan Alexandre, Tardieu Sophie, Sambuc Roland, Boubred Farid
Division of Neonatology, La Conception University Hospital, APHM, Marseille, France.
EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Aix-Marseille University, Marseille, France.
J Pediatr. 2017 Nov;190:174-179.e1. doi: 10.1016/j.jpeds.2017.08.001. Epub 2017 Sep 8.
To investigate the impact of social inequalities on the risk of rehospitalization in the first year after discharge from the neonatal unit in a population of preterm-born children.
Preterm infants were included if they were born between 2006 and 2013 at ≤32 + 6 weeks of gestation and who received follow-up in a French regional medical network with a high level of healthcare. Socioeconomic context was estimated using a neighborhood-based socioeconomic deprivation index. Univariate and logistic regression analyses were used to identify risk factors associated with rehospitalization.
For the 2325 children, the mean gestational age was 29 ± 2 weeks and the mean birth weight was 1315 ± 395 g. In the first year, 22% were rehospitalized (n = 589); respiratory diseases were the primary cause (44%). The multiple rehospitalization rate was 18%. Multivariable analysis showed that living in the most deprived neighborhoods (socioeconomic deprivation index of 5) was associated with overall rehospitalization (OR, 2.2; 95% CI, 1.5-3.6; P <.001), and multiple rehospitalizations (OR, 2.5; 95% CI, 1.2-4.9; P <.01); with socioeconomic deprivation index of 1 (least deprived) as reference. Deprivation was associated with all causes of hospitalization. Female sex (P <.001) and living in an urban area (P = .001) were protective factors.
Despite regional routine follow-up for all children, rehospitalization after very preterm birth was higher for children living in deprived neighborhoods. Families' social circumstances need to be considered when evaluating the health consequences of very preterm birth.
调查社会不平等对早产儿童新生儿病房出院后第一年再次住院风险的影响。
纳入2006年至2013年出生、孕周≤32 + 6周且在法国一个医疗水平较高的地区医疗网络接受随访的早产儿。使用基于社区的社会经济剥夺指数评估社会经济背景。采用单因素和逻辑回归分析确定与再次住院相关的风险因素。
对于2325名儿童，平均孕周为29±2周，平均出生体重为1315±395克。在第一年，22%的儿童再次住院（n = 589）；呼吸道疾病是主要原因（44%）。多次住院率为18%。多变量分析显示，生活在最贫困社区（社会经济剥夺指数为5）与总体再次住院（比值比，2.2；95%置信区间，1.5 - 3.6；P <.001）和多次再次住院（比值比，2.5；95%置信区间，1.2 - 4.9；P <.01）相关；以社会经济剥夺指数为1（最不贫困）作为参照。剥夺与所有住院原因相关。女性（P <.001）和生活在城市地区（P =.001）是保护因素。
尽管对所有儿童进行了区域常规随访，但生活在贫困社区的极早产儿出院后再次住院率更高。在评估极早产的健康后果时，需要考虑家庭的社会情况。
