Neonatal health care costs related to smoking during pregnancy
Neonatal health care costs related to smoking during pregnancy
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DOI：
10.1002/hec.660
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发表时间：
2002-04-01
期刊：
影响因子：
2.1
通讯作者：
Merritt, R
中科院分区：
文献类型：
--
作者：
Adams, EK;Miller, VP;Merritt, R
研究目的：估计吸烟造成的医疗保健费用的大部分工作都没有考虑到怀孕期间吸烟的影响和相关费用。本研究的目的是使用吸烟行为，出生结果和资源利用的数据，估计新生儿的成本归因于母亲吸烟在pregnancy.Study design：我们使用1995年的数据从疾病控制中心（CDC）的妊娠风险评估监测系统（PRAMS）数据库。PRAMS收集了来自13个州（亚拉巴马州、阿拉斯加州、加州州、佛罗里达州、格鲁吉亚州、印第安纳州、缅因州、密歇根州、纽约州（不包括纽约市）、俄克拉荷马州、南卡罗来纳州、华盛顿州和西弗吉尼亚州）和哥伦比亚特区的代表性出生样本。1995年PRAMS样本约为25 000个。多变量分析用于估计吸烟与入住NICU的概率的关系，以及分别估计入住或未入住NICU的患者的住院时间。新生儿成本是根据婴儿“现状”和“假设他们的母亲不吸烟”来预测的。两者之间的差异构成吸烟可归因的新生儿成本;这除以新生儿总成本构成吸烟可归因分数（SAF）。我们使用来自MedStat（TM）Corporation的MarketScan（TM）数据库的数据来附加NICU和非NICU托儿所夜的平均美元金额，并使用来自1997年出生证明的数据来推断所有州的SAF和可归因的费用。主要发现：分析表明，母亲吸烟使入院到NICU的相对风险增加了近20%。对于入住NICU的婴儿，母亲吸烟增加了住院时间，而对于非NICU婴儿，母亲吸烟似乎降低了住院时间。新生儿重症监护病房的婴儿在新生儿重症监护病房每晚花费2496美元，在普通托儿所每晚花费1796美元，而非新生儿重症监护病房的婴儿仅为748美元。增加的NICU使用，更长的停留时间和更高的成本相结合，导致新生儿成本的积极吸烟归因分数（SAF）。所有州的SAF为2.2%。在整个州，SAF变化从低的1.3%在得克萨斯州的4.6%在印第安纳州的高。结论：这些结果进一步证实了吸烟的不良影响。在吸烟的母亲中，吸烟使新生儿成本增加700多美元。在美国，吸烟导致的新生儿成本按1996年美元计算几乎为3.67亿美元;这些成本从较小州的不到100万美元到加州的超过3500万美元不等。这些费用是完全可以预防的，因为产妇吸烟的不利影响是短期内发生的，甚至可以通过产妇暂时戒烟来避免。这些成本估计可以由管理式医疗计划、州和地方公共卫生官员以及其他人用来评估替代性戒烟计划。版权所有（C）2002约翰威利父子有限公司
Research objective: Much of the work on estimating health care costs attributable to smoking has failed to capture the effects and related costs of smoking during pregnancy. The goal of this study is to use data on smoking behavior, birth outcomes and resource utilization to estimate neonatal costs attributable to maternal smoking during pregnancy.Study design: We use 1995 data from the Center for Disease Control's (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) database. The PRAMS collects representative samples of births from 13 states (Alabama, Alaska, California, Florida, Georgia, Indiana, Maine, Michigan, New York (excluding New York City), Oklahoma, South Carolina, Washington, and West Virginia), and the District of Columbia. The 1995 PRAMS sample is approximately 25 000. Multivariate analysis is used to estimate the relationship of smoking to probability of admission to an NICU and, separately, the length of stay for those admitted or not admitted to an NICU. Neonatal costs are predicted for infants 'as is' and 'as if their mother did not smoke. The difference between these constitutes smoking attributable neonatal costs; this divided by total neonatal costs constitutes the smoking attributable fraction (SAF). We use data from the MarketScan(TM) database of the MedStat(TM) Corporation to attach average dollar amounts to NICU and non-NICU nursery nights and data from the 1997 birth certificates to extrapolate the SAFs and attributable expenses to all states.Principal findings: The analysis showed that maternal smoking increased the relative risk of admission to an NICU by almost 20%. For infants admitted to the NICU, maternal smoking increased length of stay while for non-NICU infants it appeared to lower it. Over all births, however, smoking increased infant length of stay by 1.1%. NICU infants cost $2496 per night while in the NICU and $1796 while in a regular nursery compared to only $748 for non-NICU infants. The combination of the increased NICU use, longer stays and higher costs result in a positive smoking attributable fraction (SAF) for neonatal costs. The SAF across all states is 2.2%. Across the states, the SAF varied from a low of 1.3% in Texas to a high of 4.6% in Indiana.Conclusions: These results further confirm the adverse effects of smoking. Among mothers who smoke, smoking adds over $700 in neonatal costs. The smoking attributable neonatal costs in the US represent almost $367 million in 1996 dollars; these costs vary from less than a million in smaller states to over $35 million in California. These costs are highly preventable since the adverse effects of maternal smoking occur in the short-run and can be avoided by even a temporary cessation of maternal smoking. These cost estimates can be used by managed care plans, state and local public health officials and others to evaluate alternative smoking smoking cessation programs. Copyright (C) 2002 John Wiley Sons, Ltd.