UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK.
UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Nottingham, UK.
Addiction. 2018 Jul;113(7):1305-1316. doi: 10.1111/add.14183. Epub 2018 Mar 2.
Little is known about the long-term economic consequences of smoking during pregnancy. We estimated the association between smoking in pregnancy and the costs of delivering health-care to infants and children in England, and investigated which aspects of care are the key drivers of these costs.
We used Hospital Episode Statistics (HES) linked with Clinical Practice Research Datalink (CPRD) data in England from January 2003 to January 2015 in children with longitudinal data for at least 1, 5 and 10 years after birth. Poisson regression provided rate ratios (RR) and 95% confidence intervals (CIs) comparing health-care episode rates between those exposed and not exposed to smoking during pregnancy. Linear regression was used to compare estimated costs between groups (£ sterling, 2015 prices) and generalized linear multivariable (GLM) models adjusted for potentially moderating factors.
A total of 93 152 singleton pregnancies with the required data were identified. Maternal smoking in pregnancy was associated with higher primary care, prescription and hospital in-patient episode rates, but lower out-patient visit and diagnostic test rates. Adjusting for year of birth, socio-economic deprivation, parity, sex of child and delivery method showed that maternal smoking in pregnancy was associated with increased child health-care costs at 1 year [average cost difference for children of smokers, β = £91.18, 95% confidence interval (CI) = £47.52-134.83 and 5 years of age (β = £221.80, 95% CI = £17.78-425.83], but not at 10 years of age (β = £365.94, 95% CI = -£192.72 to £924.60).
In England, maternal smoking in pregnancy is associated with increased child health-care costs over the first 5 years of life; these costs are driven primarily by greater hospital in-patient care.
关于怀孕期间吸烟对长期经济后果的了解甚少。我们评估了妊娠期间吸烟与英国为婴儿和儿童提供医疗保健的成本之间的关系，并调查了哪些护理方面是这些成本的主要驱动因素。
我们使用了英格兰 2003 年 1 月至 2015 年 1 月期间的医院住院统计数据（HES）与临床实践研究数据链接（CPRD）数据，对至少有 1 年、5 年和 10 年出生后纵向数据的儿童进行了研究。泊松回归提供了暴露于和未暴露于妊娠期间吸烟的儿童的健康护理事件发生率之间的比率比（RR）和 95％置信区间（CI）。使用线性回归比较两组的估计费用（£ 英镑，2015 年价格），并使用广义线性多变量（GLM）模型调整潜在的调节因素。
共确定了 93152 例具有所需数据的单胎妊娠。妊娠期间母亲吸烟与更高的初级保健，处方和住院患者入院率有关，但与门诊就诊和诊断性检查率较低有关。在调整了出生年份，社会经济贫困程度，产次，孩子的性别和分娩方式后，妊娠期间母亲吸烟与 1 岁时儿童的医疗保健费用增加有关[吸烟者孩子的平均成本差异，β=£91.18，95％置信区间（CI）=£47.52-134.83和 5 岁时（β=£221.80，95％CI=£17.78-425.83]，但在 10 岁时没有（β=£365.94，95％CI=£-192.72-£924.60）。
在英格兰，妊娠期间母亲吸烟与婴儿生命头 5 年的医疗保健费用增加有关；这些成本主要由更多的住院治疗推动。
