Competing risk survival analysis of time to in-hospital death or discharge in a large urban neonatal unit in Kenya.
Competing risk survival analysis of time to in-hospital death or discharge in a large urban neonatal unit in Kenya.
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DOI：
10.12688/wellcomeopenres.15302.1
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发表时间：
2019-01-01
影响因子：
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通讯作者：
English, Mike
中科院分区：
文献类型：
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作者：
Aluvaala, Jalemba;Collins, Gary S;English, Mike
背景：临床结果数据是改善全球卫生系统努力的重要组成部分。如果要实现可持续发展目标（SDG），加强这些卫生系统至关重要。可持续发展目标 3 的具体目标 3.2 是到 2030 年消除可预防的死亡，并将新生儿死亡率降低至千分之 12 或更低。肯尼亚新生儿院内死亡率数据很少，现有卫生信息系统无法很好地获取这些数据。更好地衡量设施中的新生儿死亡率可能有助于促进医疗保健质量的提高，这对于肯尼亚等国家实现可持续发展目标 3 至关重要。方法：这是一项队列研究，使用从肯尼亚内罗毕的一个大型城市新生儿病房常规收集的数据。纳入2014年4月至2015年12月期间入住该病房的所有患者。描述性地总结了临床特征，同时考虑活着出院作为竞争风险，使用竞争风险方法来估计院内死亡的概率。结果：总共纳入 9,115 名患者。大多数是男性（966/9115，55%），大多数（6287/9115，69%）出生体重正常（2.5 至 4 公斤）。中位住院时间为 2 天（范围为 0 至 98 天），而粗死亡率为 9.2% (839/9115)。出生体重低于 1.5 千克的院内死亡概率高于活着出院的概率，出生体重在 1.5 至 1.5 千克的第一周后观察到，活着出院的概率更高
Background: Clinical outcomes data are a crucial component of efforts to improve health systems globally. Strengthening of these health systems is essential if the Sustainable Development Goals (SDG) are to be achieved. Target 3.2 of SDG Goal 3 is to end preventable deaths and reduce neonatal mortality to 12 per 1,000 or lower by 2030. There is a paucity of data on neonatal in-hospital mortality in Kenya that is poorly captured in the existing health information system. Better measurement of neonatal mortality in facilities may help promote improvements in the quality of health care that will be important to achieving SDG 3 in countries such as Kenya. Methods: This was a cohort study using routinely collected data from a large urban neonatal unit in Nairobi, Kenya. All the patients admitted to the unit between April 2014 to December 2015 were included. Clinical characteristics are summarised descriptively, while the competing risk method was used to estimate the probability of in-hospital mortality considering discharge alive as the competing risk. Results: A total of 9,115 patients were included. Most were males (966/9115, 55%) and the majority (6287/9115, 69%) had normal birthweight (2.5 to 4 kg). Median length of stay was 2 days (range, 0 to 98 days) while crude mortality was 9.2% (839/9115). The probability of in-hospital death was higher than discharge alive for birthweight less than 1.5 kg with the transition to higher probability of discharge alive observed after the first week in birthweight 1.5 to