Mothers of children with major congenital anomalies have increased health care utilization over a 20-year post-birth time horizon
Autor: | Nirav R. Shah, Kyung Mi Kim, Venus Wong, Eyal Cohen, Sarah Rosenbaum, Eli M. Cahan, Arnold Milstein, Henrik Toft Sørensen, Erzsébet Horváth-Puhó |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Adult
Male Time Factors Adolescent Patients Epidemiology Denmark Science Mothers Surgical and Invasive Medical Procedures Congenital Abnormalities Cohort Studies Families Pediatric Surgery Pregnancy Risk Factors Odds Ratio Prevalence Medicine and Health Sciences Humans Registries Child Outpatient Clinics Children Inpatients Multidisciplinary Infant Newborn Infant Patient Acceptance of Health Care Health Care Age Groups Health Care Facilities Case-Control Studies Child Preschool Medical Risk Factors People and Places Health Care Utilization Medicine Female Population Groupings Infants Research Article |
Zdroj: | PLoS ONE, Vol 16, Iss 12, p e0260962 (2021) Shah, N R, Kim, K M, Wong, V, Cohen, E, Rosenbaum, S, Cahan, E M, Milstein, A, Sørensen, H T & Horvath-Puho, E 2021, ' Mothers of children with major congenital anomalies have increased health care utilization over a 20-year post-birth time horizon ', PLOS ONE, vol. 16, no. 12, e0260962 . https://doi.org/10.1371/journal.pone.0260962 PLoS ONE, Vol 16, Iss 12 (2021) PLoS ONE |
ISSN: | 1932-6203 |
Popis: | Objective This population-based, matched cohort study aimed to evaluate utilization of health care services by mothers of children with major congenital anomalies (MCAs), compared to mothers of children without MCAs over a 20-year post-birth time horizon in Denmark. Methods Our analytic sample included mothers who gave birth to an infant with a MCA (n = 23,927) and a cohort of mothers matched to them by maternal age, parity and infant’s year of birth (n = 239,076). Primary outcomes were period prevalence and mothers’ quantity of health care utilization (primary, inpatient, outpatient, surgical, and psychiatric services) stratified by their child’s age (i.e., ages 0–6 = before school, ages 7–13 = pre-school + primary education, and ages 14–18 = secondary education or higher). The secondary outcome measure was length of hospital stays. Outcome measures were adjusted for maternal age at delivery, parity, marital status, income quartile, level of education in the year prior to the index birth, previous spontaneous abortions, maternal pregnancy complications, maternal diabetes, hypertension, alcohol-related diseases, and maternal smoking. Results In both cohorts the majority of mothers were between 26 and 35 years of age, married, and employed, and 47% were primiparous. Mothers of infants with anomalies had greater utilization of outpatient, inpatient, surgical, and psychiatric services, compared with mothers in the matched cohort. Inpatient service utilization was greater in the exposed cohort up to 13 years after a child’s birth, with the highest risk in the first six years after birth [adjusted risk ratio, 1.13; 95% confidence interval (CI), 1.12–1.14], with a decrease over time. Regarding the quantity of health care utilization, the greatest difference between the two groups was in inpatient service utilization, with a 39% increased rate in the exposed cohort during the first six years after birth (adjusted rate ratio, 1.39; 95% CI, 1.37–1.42). During the first 6 years after birth, mothers of children with anomalies stayed a median of 6 days (interquartile range [IQR], 3–13) in hospital overall, while the comparison cohort stayed a median of 4 days (IQR, 2–7) in hospital overall. Rates of utilization of outpatient clinics (adjusted rate ratio, 1.36; 95% CI, 1.29–1.42), as well as inpatient (adjusted rate ratio, 1.77; 95% CI, 1.68–1.87), and surgical services (adjusted rate ratio, 1.33; 95% CI, 1.26–1.41) was higher in mothers of children with multiple-organ MCAs during 0 to 6 years after birth. Among mothers at the lowest income levels, utilization of psychiatric clinic services increased to 59% and when their child was 7 to 13 years of age (adjusted rate ratio, 1.59; 95% CI, 1.24–2.03). Conclusion Mothers of infants with a major congenital anomaly had greater health care utilization across services. Health care utilization decreased over time or remained stable for outpatient, inpatient, and surgical care services, whereas psychiatric utilization increased for up to 13 years after an affected child’s birth. Healthcare utilization was significantly elevated among mothers of children with multiple MCAs and among those at the lowest income levels. |
Databáze: | OpenAIRE |
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