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Regional variation in late preterm births in North Carolina
Sofia R Aliaga1, P Brian Smith, Wayne A Price
1Department of Pediatrics, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27599, USA. saliaga@med.unc.edu
Insights
Late preterm (LPT) births show regional variation in North Carolina, even after accounting for risk factors. Provider practices may explain these differences, suggesting opportunities for quality improvement to reduce LPT births.
Area of Science:
- Neonatal Health
- Public Health
- Health Services Research
Background:
- Late preterm (LPT) neonates (34 0/7th-36 6/7th weeks' gestation) represent 70% of US premature births.
- LPT neonates face increased morbidity and mortality risks compared to term neonates.
- Geographic variations in LPT birth rates suggest potential systemic or practice-related differences.
Purpose of the Study:
- To identify and quantify regional variations in LPT births within North Carolina.
- To determine if these variations persist after controlling for sociodemographic and medical/obstetric risk factors.
- To explore potential drivers of unexplained variation in LPT birth rates.
Main Methods:
- Utilized the NC State Center for Health Statistics linked birth-death certificate database (1999-2006).
- Included all singleton term and LPT neonates born within the study period.
- Employed multivariable logistic regression to adjust for confounding factors.
Main Results:
- Analyzed 884,304 neonates, with 66,218 (7.5%) identified as LPT.
- Identified significant regional variation in adjusted LPT birth percentages across North Carolina's six perinatal regions.
- Regions 2 (7.0%) and 6 (6.6%) exhibited the highest adjusted percentages of LPT births.
Conclusions:
- Regional disparities in LPT birth incidence exist in North Carolina, independent of known risk factors.
- Provider practice variation is a potential explanation for the observed unwarranted variation.
- Targeted policy changes and quality improvement initiatives are recommended to reduce LPT birth rates and associated risks.
Abstract:
Late preterm (LPT) neonates (34 0/7th-36 6/7th weeks' gestation) account for 70% of all premature births in the United States. LPT neonates have a higher morbidity and mortality risk than term neonates. LPT birth rates vary across geographic regions. Unwarranted variation is variation in medical care that cannot be explained by sociodemographic or medical risk factors; it represents differences in health system performance, including provider practice variation. The purpose of this study is to identify regional variation in LPT births in North Carolina that cannot be explained by sociodemographic or medical/obstetric risk factors. We searched the NC State Center for Health Statistics linked birth-death certificate database for all singleton term and LPT neonates born between 1999 and 2006. We used multivariable logistic regression analysis to control for socio-demographic and medical/obstetric risk factors. The main outcome was the percent of LPT birth in each of the six perinatal regions in North Carolina. We identified 884,304 neonates; 66,218 (7.5%) were LPT. After multivariable logistic regression, regions 2 (7.0%) and 6 (6.6%) had the highest adjusted percent of LPT birth. Analysis of a statewide birth cohort demonstrates regional variation in the incidence of LPT births among NC's perinatal regions after adjustment for sociodemographic and medical risk factors. We speculate that provider practice variation might explain some of the remaining difference. This is an area where policy changes and quality improvement efforts can help reduce variation, and potentially decrease LPT births.
