Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia.
Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University, Prague, Czechia.
PLoS One. 2023 Apr 13;18(4):e0284159. doi: 10.1371/journal.pone.0284159. eCollection 2023.
Fertility postponement, which has comprised the most significant reproductive trend in developed countries over the last few decades, involves a number of social, personal and health consequences. The length of stay (LOS) in hospital following childbirth varies considerably between countries. Czechia, where the fertility postponement process has been particularly dynamic, has one of the longest mean LOS of the OECD member countries.
We analyse the influence of the age of mothers on the LOS in hospital associated with childbirth.
We employed anonymised individual data provided by the General Health Insurance Company of the Czech Republic on women who gave birth in 2014. Kaplan-Meier survival plots and binary logistic regression were employed to identify factors associated with long stays (> = 7 days for vaginal births, > = 9 days for CS births).
The impact of the maternal age on the LOS is U-shaped. A higher risk of a longer hospitalisation period for young mothers was identified for both types of birth (OR = 1.58, 95% CI 1.33-1.87, p˂0.001 for age less than 20, OR = 1.31, 95% CI 1.20-1.44, p˂0.001 for age 20-24 compared to 30-34). The risk of a longer stay in hospital increases with the increasing age of the mother (OR = 1.23, 95% CI 1.13-1.35, p˂0.001 for age 35-39, OR = 2.05, 95% CI 1.73-2.44, p˂0.001 for age 40+ compared to 30-34), especially with concern to vaginal births.
The probability of a long LOS increases significantly after the age of 35, especially in the case of vaginal births. Thus, the fertility postponement process with the significant change in the age structure of mothers contributes to the increase in health care costs associated with post-birth hospitalisation.
生育推迟是过去几十年发达国家最显著的生育趋势之一，涉及到许多社会、个人和健康方面的后果。不同国家的产后住院时间（LOS）差异很大。在生育推迟过程中尤为活跃的捷克，其产后住院时间是经合组织成员国中最长的之一。
我们分析母亲年龄对与分娩相关的住院 LOS 的影响。
我们使用捷克共和国普通健康保险公司提供的匿名个人数据，对 2014 年分娩的妇女进行分析。采用 Kaplan-Meier 生存图和二项逻辑回归来确定与较长住院时间（阴道分娩> = 7 天，CS 分娩> = 9 天）相关的因素。
母亲年龄对 LOS 的影响呈 U 型。我们发现，年轻母亲的两种分娩方式（年龄<20 岁时，OR = 1.58，95%CI 1.33-1.87，p˂0.001；20-24 岁时，OR = 1.31，95%CI 1.20-1.44，p˂0.001）的住院时间更长的风险更高。随着母亲年龄的增加，住院时间延长的风险也随之增加（年龄 35-39 岁时，OR = 1.23，95%CI 1.13-1.35，p˂0.001；40 岁及以上时，OR = 2.05，95%CI 1.73-2.44，p˂0.001），尤其是阴道分娩。
年龄超过 35 岁后，LOS 变长的概率显著增加，尤其是阴道分娩。因此，生育推迟过程中母亲年龄结构的重大变化导致与产后住院相关的医疗保健费用增加。
