Hayeems Robin Z, Miller Fiona A, Vermeulen Marian, Potter Beth K, Chakraborty Pranesh, Davies Christine, Carroll June C, Ratjen Felix, Guttmann Astrid
Child Health Evaluative Sciences Program and
Institute of Health Policy, Management and Evaluation.
Pediatrics. 2017 Nov;140(5). doi: 10.1542/peds.2017-0604. Epub 2017 Oct 12.
Evidence is mixed regarding the impact of false-positive (FP) newborn bloodspot screening (NBS) results on health care use. Using cystic fibrosis (CF) as an example, we determined the association of FP NBS results with health care use in infants and their mothers in Ontario, Canada.
We conducted a population-based cohort study of all infants with FP CF results ( = 1564) and screen-negative matched controls ( = 6256) born between April 2008 and November 2012 using linked health administrative data. Outcomes included maternal and infant physician and emergency visits and inpatient hospitalizations from the infant's third to 15th month of age. Negative binomial regression tested associations of NBS status with outcomes, adjusting for infant and maternal characteristics.
A greater proportion of infants with FP results had >2 outpatient visits (16.2% vs 13.2%) and >2 hospital admissions (1.5% vs 0.7%) compared with controls; CF-related admissions and emergency department visits were not different from controls. Differences persisted after adjustment, with higher rates of outpatient visits (relative risk 1.39; 95% confidence interval 1.20-1.60) and hospital admissions (relative risk 1.67; 95% confidence interval 1.21-2.31) for FP infants. Stratified models indicated the effect of FP status was greater among those whose primary care provider was a pediatrician. No differences in health care use among mothers were detected.
Higher use of outpatient services among FP infants may relate to a lengthy confirmatory testing process or follow-up carrier testing. However, increased rates of hospitalization might signal heightened perceptions of vulnerability among healthy infants.
关于假阳性新生儿血斑筛查（NBS）结果对医疗保健利用的影响，证据不一。以囊性纤维化（CF）为例，我们确定了加拿大安大略省假阳性NBS结果与婴儿及其母亲医疗保健利用之间的关联。
我们使用关联的卫生行政数据，对2008年4月至2012年11月期间出生的所有CF筛查结果为假阳性的婴儿（n = 1564）和筛查阴性的匹配对照（n = 6256）进行了一项基于人群的队列研究。结局包括婴儿从第三个月到第十五个月的母婴医生就诊、急诊就诊和住院情况。负二项回归检验了NBS状态与结局之间的关联，并对婴儿和母亲的特征进行了调整。
与对照组相比，假阳性结果的婴儿中有更大比例的婴儿门诊就诊次数>2次（16.2%对13.2%）和住院次数>2次（1.5%对0.7%）；与CF相关的住院和急诊就诊与对照组无差异。调整后差异仍然存在，假阳性婴儿的门诊就诊率（相对风险1.39；95%置信区间1.20 - 1.60）和住院率（相对风险1.67；95%置信区间1.21 - 2.31）更高。分层模型表明，在初级保健提供者为儿科医生的人群中，假阳性状态的影响更大。未检测到母亲在医疗保健利用方面的差异。
假阳性婴儿门诊服务使用率较高可能与漫长的确诊检测过程或后续携带者检测有关。然而，住院率增加可能表明健康婴儿的脆弱感增强。
