Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynecology, and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Radiology, and Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
J Pediatr. 2019 Jun;209:61-67.e2. doi: 10.1016/j.jpeds.2019.02.031. Epub 2019 Apr 2.
To examine the association between cesarean delivery and healthcare utilization and costs in offspring from birth until age 7 years.
A retrospective cohort study of singleton term births in the Canadian province of Nova Scotia between 2003 and 2007 followed until age 7 years was conducted using data from the Nova Scotia Atlee Perinatal Database and administrative health data. The main exposure was mode of delivery (cesarean delivery vs vaginal birth); the outcome was healthcare utilization and costs during the first 7 years of life. Associations were modeled using multiple regression adjusting for maternal prepregnancy weight and sociodemographic factors.
In total, 32 464 births were included in the analysis. Compared with children born by vaginal birth, children born by cesarean delivery had more physician visits (incidence rate ratio 1.06, 95% CI 1.05-1.08) and longer hospital stays (incidence rate ratio 1.12, 95% CI 1.03-1.21) and were more likely to be high utilizers of physician visits (OR 1.23, 95% CI 1.10-1.37). Physician and hospital costs were $775 higher for children born by cesarean delivery compared with vaginal birth.
Cesarean delivery compared with vaginal birth is associated with small but statistically significant increases in healthcare utilization and costs during the first 7 years of life.
研究剖宫产与子代出生至 7 岁时的医疗保健利用和费用之间的关联。
采用回顾性队列研究，对 2003 年至 2007 年间加拿大新斯科舍省的单胎足月分娩病例进行研究，随访至 7 岁，研究数据来源于新斯科舍阿特利围产数据库和行政健康数据。主要暴露因素为分娩方式（剖宫产与阴道分娩）；结局为出生后 7 年内的医疗保健利用和费用。采用多元回归模型，在校正了母亲孕前体重和社会人口学因素后，对关联进行了分析。
共纳入 32464 例分娩病例。与阴道分娩出生的儿童相比，剖宫产出生的儿童就诊次数更多（发生率比 1.06，95%CI 1.05-1.08），住院时间更长（发生率比 1.12，95%CI 1.03-1.21），更有可能成为高就诊次数者（比值比 1.23，95%CI 1.10-1.37）。与阴道分娩相比，剖宫产儿童的医生和住院费用高出 775 美元。
与阴道分娩相比，剖宫产与子代出生后 7 年内医疗保健利用和费用的小但有统计学意义的增加有关。
