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Impact of birthweight on health-care utilization during early childhood - a birth cohort study
Mario Rüdiger1, Luise Heinrich2, Katrin Arnold2
1Department for Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. Mario.Ruediger@uniklinikum-dresden.de.
Insights
Infants with low birthweight, especially very low birthweight (VLBW), face significantly higher healthcare utilization and costs throughout early childhood. This burden extends beyond the first year of life, impacting clinical and economic resources.
Area of Science:
- Pediatrics
- Public Health
- Health Economics
Background:
- Low birthweight poses a significant public health challenge.
- Comprehensive data are needed to understand the full burden of low birthweight on healthcare systems.
- Existing research often focuses on the neonatal period, neglecting long-term impacts.
Purpose of the Study:
- To evaluate the burden of low birthweight on inpatient healthcare utilization and costs in early childhood.
- To compare morbidity patterns between low birthweight and normal birthweight infants.
- To test the hypothesis of increased healthcare utilization and costs in low birthweight infants.
Main Methods:
- Analysis of routine health-care utilization data for infants born between 2007-2013.
- Classification of infants into very low birthweight (<1500g), low birthweight (1500-2499g), and normal birthweight groups.
- Quantification of inpatient utilization (hospital stays, costs) and reasons for hospitalization by year of life.
Main Results:
- Very low birthweight infants had a >5-fold increased risk of hospitalization for various conditions in the first year of life.
- Median cumulative inpatient costs during the first four years were significantly higher for very low birthweight (€2953) and low birthweight (€1331) infants compared to normal birthweight infants (€0).
- Inpatient utilization remained higher for very low birthweight infants after the first year, with increased risks observed for rural residents and boys.
Conclusions:
- Low birthweight, particularly very low birthweight, imposes a substantial and prolonged clinical and economic burden on healthcare systems.
- The impact of low birthweight on healthcare utilization and costs extends well beyond the neonatal period.
- Findings highlight the need for continued monitoring and resource allocation for low birthweight infants throughout early childhood.
Background:
Comprehensive data are needed to evaluate the burden of low birthweight. Analysis of routine data on health-care utilization during early childhood were used to test the hypothesis that infants with low birthweight have (i) increased inpatient health-care utilization, (ii) higher hospital costs and (iii) different morbidity pattern in early childhood when compared with normal birthweight infants.
Methods:
Children born between 2007 and 2013 that were insured at birth with the statutory health insurance AOK PLUS were included (N = 118,166, equaling 49% of the Saxon newborns) and classified into very low (< 1500 g, VLBW), low (1500-2499 g, LBW) birthweight and reference group (> 2500 g). Outcomes were: inpatient health-care utilization quantified by number and length of hospital stays; costs of hospitalizations including medication; reasons of hospitalizations for each year of life (YOL).
Results:
72, 38 and 22% of VLBW-, LBW- and reference group were hospitalized after perinatal period within the first YOL with a more than 5-fold increased risk in VLBW to be hospitalized for hemangioma, convulsions, hydrocephalus, hernia and respiratory problems. Median (IQR) cumulative cost of inpatient care during the first four YOLs was 2953 (1213-7885), 1331 (0-3451) and 0 (0-2062) Euro for respective groups. Inpatient early childhood health-care utilization (after first YOL) was higher in VLBW compared to healthy, normal birth weight infants (RR 3.92 [95%-CI 3.63, 4.23]), residents of rural areas (RR 1.37 [95%-CI 1.35, 1.40]) and in boys (RR 1.31 [95%-CI 1.29, 1.33]).
Conclusion:
This large population-based birth-cohort study indicates a high clinical and economic burden of low birthweight which is not restricted to the first year of life.
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