Haile Tsegaye G, Pereira Gavin, Norman Richard, Tessema Gizachew A
Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.
Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
PLOS Glob Public Health. 2025 Aug 7;5(8):e0004985. doi: 10.1371/journal.pgph.0004985. eCollection 2025.
Adverse perinatal outcomes, including preterm birth (PTB), small-for-gestational-age (SGA), and low birthweight (LBW), impact childhood health and impose substantial burdens. This retrospective cohort study included all births in the Northern Territory, Australia, from July 1, 2000, to June 30, 2016, examining trends in these outcomes and related hospitalisations, emergency department (ED) presentations, and healthcare costs through June 30, 2021. Births were linked to hospitalisation, ED, and cost-weight data. Cost, adjusted to June 2024 Australian Dollars (AUD), includes both direct medical and non-medical components. A Generalized Additive Model with a gamma distribution and log link was used to identify cost drivers. A total of 31,183 and 42,174 births were linked to hospitalisations and ED records, respectively. The incidence of PTB increased from 8.1% to 8.7%, while SGA declined from 15.2% to 11.3%. The mean number of hospitalisations by age five increased for children with PTB (1.3 ± 0.7 to 6.9 ± 6.0), and SGA (1.2 ± 0.6 to 8.1 ± 15.1), despite a decline in length of stay. ED presentations also increased for children with PTB (1.3 ± 0.5 to 11.5 ± 10.7), SGA (2.2 ± 1.9 to 12.2 ± 11.5), and LBW (1.2 ± 0.2 to 10.9 ± 8.7). Median five-year hospitalisations cost was AUD 23,848 (IQR: 11,858-44,475) for children with PTB and SGA, compared with AUD 8,668 (IQR: 4,365-17,855) for term non-SGA children. ED cost was AUD 3,108 (IQR: 1,609-7,520) versus AUD 2,058 (IQR: 1,032-4,057), respectively. Costs increased over time for SGA and LBW but declined slightly for PTB. Higher costs than the national average were observed among Indigenous children, those from remote areas, and those with prolonged hospital stays. The healthcare burden associated with adverse perinatal has increased in recent cohorts, particularly among vulnerable groups. Future studies should quantify these burdens across population subgroups to better inform policy.
不良围产期结局，包括早产（PTB）、小于胎龄儿（SGA）和低出生体重（LBW），会影响儿童健康并带来沉重负担。这项回顾性队列研究纳入了2000年7月1日至2016年6月30日在澳大利亚北领地的所有分娩，研究这些结局以及相关住院治疗、急诊科就诊情况和截至2021年6月30日的医疗费用趋势。分娩记录与住院治疗、急诊科就诊及费用权重数据相关联。费用按2024年6月澳元（AUD）进行调整，包括直接医疗和非医疗部分。使用具有伽马分布和对数链接的广义相加模型来确定费用驱动因素。分别有31,183例和42,174例分娩与住院治疗记录和急诊科记录相关联。早产的发生率从8.1%升至8.7%，而小于胎龄儿从15.2%降至11.3%。早产儿童（从1.3±0.7升至6.9±6.0）和小于胎龄儿（从1.2±0.6升至8.1±15.1）五岁前的平均住院次数增加，尽管住院时长有所下降。早产儿童（从1.3±0.5升至11.5±10.7）、小于胎龄儿（从2.2±1.9升至12.2±11.5）和低出生体重儿（从1.2±0.2升至10.9±8.7）到急诊科就诊的次数也增加了。早产和小于胎龄儿五岁的住院治疗费用中位数为23,848澳元（四分位距：11,858 - 44,475），而足月非小于胎龄儿为8,668澳元（四分位距：4,365 - 17,855）。急诊科费用分别为3,108澳元（四分位距：1,609 - 7,520）和2,058澳元（四分位距：1,032 - 4,057）。小于胎龄儿和低出生体重儿的费用随时间增加，而早产则略有下降。在原住民儿童、偏远地区儿童以及住院时间延长的儿童中，观察到费用高于全国平均水平。在最近的队列中，与不良围产期相关的医疗负担有所增加，尤其是在弱势群体中。未来的研究应量化不同人群亚组的这些负担，以便为政策提供更充分的信息。
