Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA.
Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.
Nicotine Tob Res. 2024 Oct 22;26(11):1530-1537. doi: 10.1093/ntr/ntae128.
Identifying healthcare utilization and costs associated with active and passive smoking during pregnancy could help improve health management strategies.
Data are from the Newborn Epigenetics STudy (NEST), a birth cohort enrolled from 2005 to 2011 in Durham and adjacent counties in North Carolina, United States. Participants included those for whom prenatal serum samples were assayed and for whom administrative data were obtainable (N = 1045). Zero-inflated poisson regression models were used to assess associations between cotinine, adjusted for covariates (eg, race and ethnicity, age at delivery, cohabitation status, and education), and health care utilization outcomes. Generalized linear regression models were used to estimate average total charges. Simulation models were conducted to determine the economic benefits of reducing secondhand smoke and smoking during pregnancy.
Increasing levels of cotinine were positively associated with parent's number of emergency department (ED) visits (coefficient[b] = 0.0012, standard error [SE] = 0.0002; p < .001), the number of ICU hours (b = 0.0079, SE = 0.0025; p = .002), time spent in the ICU (b = 0.0238, SE = 0.0020, p < .001), and the number of OP visits (b = 0.0003, SE = 0.0001; p < .001). For infants, higher cotinine levels were associated with higher number of ED (b = 0.0012, SE = 0.0004; p = .005), ICU (b = 0.0050, SE = 0.001; p < .001), and OP (b = 0.0006, SE = 0.0002; p < .001) visits and longer time spent in the ED (b = 0.0025, SE = 0.0003; p < .001), ICU (b = 0.0005, SE = 0.0001; p < .001), and IP (b = 0.0020, SE = 0.0002; p < .001). Simulation results showed that a 5% reduction in smoking would correspond to a potential median cost savings of $150 533 from ED visits of parents and infants.
Our findings highlight the importance of smoke exposure cessation during pregnancy to reduce health care utilization and costs for both parents and infants.
This study reinforces the importance of reducing smoking and secondhand smoke exposure during pregnancy. Focusing on expanding cessation services to this group could help reduce morbidities observed within this population. Furthermore, there is the potential for healthcare cost savings to healthcare systems, especially for those with high delivery numbers. These cost savings are represented by potential reductions in ED, OP, and ICU hours and visits.
识别与怀孕期间主动和被动吸烟相关的医疗保健利用和费用，可能有助于改善健康管理策略。
数据来自新生儿表观遗传学研究（NEST），这是一项于 2005 年至 2011 年在美国北卡罗来纳州达勒姆及其毗邻县招募的出生队列研究。参与者包括接受过产前血清样本检测且可获得行政数据的人（N=1045）。使用零膨胀泊松回归模型评估了与可替宁相关的关联，可替宁经过了协变量（例如种族和民族、分娩时的年龄、同居状况和教育程度）的调整，并评估了与医疗保健利用结果的关联。使用广义线性回归模型估计了总费用的平均值。进行模拟模型以确定减少二手烟和怀孕期间吸烟的经济效益。
可替宁水平的升高与父母急诊就诊次数（系数[b]=0.0012，标准误差[SE]=0.0002；p<0.001）、重症监护病房（ICU）小时数（b=0.0079，SE=0.0025；p=0.002）、在 ICU 中花费的时间（b=0.0238，SE=0.0020，p<0.001）和就诊次数（b=0.0003，SE=0.0001；p<0.001）呈正相关。对于婴儿，较高的可替宁水平与较高的急诊就诊次数（b=0.0012，SE=0.0004；p=0.005）、ICU（b=0.0050，SE=0.001；p<0.001）和 OP（b=0.0006，SE=0.0002；p<0.001）就诊次数以及在 ED（b=0.0025，SE=0.0003；p<0.001）、ICU（b=0.0005，SE=0.0001；p<0.001）和 IP（b=0.0020，SE=0.0002；p<0.001）中花费的时间较长有关。
模拟结果表明，吸烟减少 5%可能会使父母和婴儿的急诊就诊费用中位数降低 150533 美元。
我们的研究结果强调了在怀孕期间停止吸烟的重要性，以减少父母和婴儿的医疗保健利用和费用。
这项研究强调了减少怀孕期间吸烟和二手烟暴露的重要性。专注于为这一群体扩大戒烟服务，有助于减轻这一人群中观察到的发病率。此外，对医疗保健系统来说，还有可能节省医疗保健费用，特别是对那些分娩数量较高的系统来说。这些节省的成本代表了 ED、OP 和 ICU 小时数和就诊次数的潜在减少。
