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Cesarean Delivery and Healthcare Utilization and Costs in the Offspring: A Retrospective Cohort Study
Alexander Nikolas MacLellan1, Christy G Woolcott1, Mary Margaret Brown1
1Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynecology, and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Children born via cesarean delivery experienced higher healthcare utilization and costs up to age seven compared to those born vaginally. This study highlights the long-term economic impact of delivery method on pediatric healthcare needs.
Area of Science:
- Perinatal health outcomes
- Pediatric healthcare economics
- Reproductive medicine
Background:
- Cesarean delivery rates have increased globally.
- Understanding long-term healthcare implications of delivery mode is crucial for resource allocation.
- Previous studies have focused on shorter-term outcomes.
Purpose of the Study:
- To investigate the association between cesarean delivery and healthcare utilization and costs in offspring.
- To track healthcare resource use from birth up to age seven years.
Main Methods:
- Retrospective cohort study utilizing Canadian provincial health administrative data.
- Inclusion of singleton term births in Nova Scotia (2003-2007) followed until age seven.
- Multiple regression analysis adjusted for maternal pre-pregnancy weight and sociodemographic factors.
Main Results:
- Children born by cesarean delivery had more physician visits (IRR 1.06) and longer hospital stays (IRR 1.12).
- Cesarean-born children were more likely to be high utilizers of physician visits (OR 1.23).
- Average healthcare costs were $775 higher for cesarean-born children by age seven.
Conclusions:
- Cesarean delivery is linked to modest but statistically significant increases in pediatric healthcare utilization.
- These findings suggest a potential long-term economic impact associated with cesarean births.
- Further research into the specific drivers of increased utilization is warranted.
Objective:
To examine the association between cesarean delivery and healthcare utilization and costs in offspring from birth until age 7 years.
Study Design:
A retrospective cohort study of singleton term births in the Canadian province of Nova Scotia between 2003 and 2007 followed until age 7 years was conducted using data from the Nova Scotia Atlee Perinatal Database and administrative health data. The main exposure was mode of delivery (cesarean delivery vs vaginal birth); the outcome was healthcare utilization and costs during the first 7 years of life. Associations were modeled using multiple regression adjusting for maternal prepregnancy weight and sociodemographic factors.
Results:
In total, 32 464 births were included in the analysis. Compared with children born by vaginal birth, children born by cesarean delivery had more physician visits (incidence rate ratio 1.06, 95% CI 1.05-1.08) and longer hospital stays (incidence rate ratio 1.12, 95% CI 1.03-1.21) and were more likely to be high utilizers of physician visits (OR 1.23, 95% CI 1.10-1.37). Physician and hospital costs were $775 higher for children born by cesarean delivery compared with vaginal birth.
Conclusions:
Cesarean delivery compared with vaginal birth is associated with small but statistically significant increases in healthcare utilization and costs during the first 7 years of life.
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