Evaluating the Effect of Hospital and Insurance Type on the Risk of 1-year Mortality of Very Low Birth Weight Infants: Controlling for Selection Bias : Medical Care

Secondary Logo

Journal Logo

Original Article

Evaluating the Effect of Hospital and Insurance Type on the Risk of 1-year Mortality of Very Low Birth Weight Infants

Controlling for Selection Bias

Ounpraseuth, Songthip PhD*; Gauss, C. Heath MS*; Bronstein, Janet PhD; Lowery, Curtis MD; Nugent, Richard MD; Hall, Richard MD

Author Information
Medical Care 50(4):p 353-360, April 2012. | DOI: 10.1097/MLR.0b013e318245a128

Abstract

Objectives: 

We examined the effect of hospital type and medical coverage on the risk of 1-year mortality of very low birth weight (VLBW) infants while adjusting for possible selection bias.

Methods: 

The study population was limited to singleton live birth infants having birth weight between 500 and 1500 g with no congenital anomalies who were born in Arkansas hospitals between 2001 and 2007. Propensity score (PS) matching and PS covariate adjustment were used to mitigate selection bias. In addition, a conventional multivariable logistic regression model was used for comparison purposes.

Results: 

Generally, all 3 analytical approaches provided consistent results in terms of the estimated relative risk, absolute risk reduction, and the number needed to treat. Using the PS matching method, VLBW infants delivered at a hospital with a neonatal intensive care unit (NICU) were associated with a 35% relative decrease (95% bootstrap confidence interval, 18.5%–48.9%) in the risk of 1-year mortality as compared with those infants delivered at non-NICU hospitals. Furthermore, our results showed that on average, 16 VLBW infants (95% bootstrap confidence interval, 11–32), would need to be delivered at a hospital with an NICU to prevent 1 additional death at 1 year. However, there was not a difference in the risk of 1-year mortality between VLBW infants born to Medicaid-insured versus non–Medicaid-insured women.

Conclusions: 

Estimated relative risk of infant mortality was significantly lower for births that occurred in hospitals with an NICU; therefore, greater efforts should be made to deliver VLBW neonates in an NICU hospital.

© 2012 Lippincott Williams & Wilkins, Inc.

You can read the full text of this article if you:

Access through Ovid