Burden of Late-Pre term Births throughout the First Year of Life

生命第一年晚期早产的负担

• 批准号: 8137337
• 负责人: Donna R. Halloran
• 金额: $ 13.04万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-05 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8137337
• 关键词: Accounting; Asthma; Biometry; Birth; Birth Certificates; Blue Cross; Blue Shield; Bronchiolitis; Caring; Categories; Clinical Sciences; Data; Databases; Development; Diagnosis; Disease; Doctor of Philosophy; Drug Prescriptions; Environment; Epidemiology; Fellowship; Foundations; Future; Gestational Age; Health; Health Care Costs; Health Services Research; Health Services for the Aged; Hospitalization; Hospitals; Incidence; Infant; Infant Care; Infant Mortality; Inpatients; Institutes; Insurance; Intervention; Lead; Life; Link; Master of Science; Medicaid; Mentors; Mentorship; Missouri; Morbidity - disease rate; Neonatology; Newborn Respiratory Distress Syndrome; Outcomes Research; Outpatients; Pediatrics; Perinatal; Pharmaceutical Preparations; Pneumonia; Population; Population Heterogeneity; Positioning Attribute; Pregnancy; Premature Birth; Premature Infant; Process; Public Health; Public Health Schools; Race; Records; Relative Risks; Research; Research Design; Research Personnel; Respiratory Failure; Risk; Risk Assessment; Risk Factors; Services; Societies; Socioeconomic Status; Source; System; Term Birth; Training; Translational Research; United States; Universities; Washington; base; care systems; cost; experience; fetal medicine; health care service utilization; health economics; improved; infancy; infant outcome; inpatient service; medical schools; mortality; multidisciplinary; perinatal health; population based; prospective; public health relevance; respiratory

DESCRIPTION (provided by applicant): Summary More than 70% of preterm infants are born between 34 and 36 completed weeks of gestation or late preterm. This is the equivalent of 8% of all infants born in the United States each year. These infants are at increased risk for morbidity and mortality in the perinatal period and are twice as likely to die in the first year of life. Despite this, only preliminary research has been done to explore the morbidity of these infants in the first year of life. Overarching hypothesis: Late preterm infants are at increased risk for morbidity beyond the perinatal period. Specific Aim 1: Describe the incidence and risk factors for late preterm delivery in a sociodemographically-diverse population using private and public administrative claims data linked to birth certificate records. Hypothesis: Race and socioeconomic status are independent risk factors for late preterm delivery. Dr. Halloran will link birth certificate records to private and public insurance claims data. She will describe the incidence and risk factors for late preterm birth among a racially- and economically-diverse group to increase the understanding of the inadequately-defined epidemiology of late-preterm births. Specific Aim 2: Evaluate cause-specific and gestational-age-specific morbidity in late preterm and term infants over the first year of life, specifically respiratory-related conditions. Hypothesis: Late preterm infants are twice as likely to have respiratory diagnoses, respiratory-related medication use, and respiratory-related hospitalizations compared to term infants. Dr. Halloran will characterize the association of gestational age with respiratory complications including respiratory-related diagnoses, inpatient/outpatient health care utilization, and medication use in late preterm versus term infants. Specific Aim 3: Determine the difference in cost of infant care in late preterm versus term infants in the first year of life using population-based data which includes private and public claims data linked to birth certificate records. Hypothesis: Late preterm infants have at least 100% increase in total cost of care during the first year of life compared to term infants. Dr. Halloran will examine the total cost (inpatient, outpatient, and prescription drugs) and system-specific cost in late preterm versus term infants throughout the first year of life. Following a research fellowship and Masters of Science in Public Health, Dr. Halloran is on the tenure-track in the Division of General Pediatrics at St. Louis University (SLU). She has chosen a multidisciplinary panel of mentors with expertise and experience in maternal-fetal medicine, neonatology, health services research, health economics, and biostatistics. This committee in combination with the support of the SLU School of Medicine, SLU School of Public Health, and Washington University Institute of Clinical and Translational Science will provide her with a strong research environment. Through advanced statistical training as part of a PhD in Outcomes Research and the mentorship of a diverse, experienced group of mentors and advisors, Dr. Halloran will be well-positioned to become an independent investigator in infant outcomes research. PUBLIC HEALTH RELEVANCE: This proposal will lead to the development a risk-based system to sub classify the heterogeneous category of late-preterm infants and improve the precision of risk assessment in this population. This project will lay the groundwork for future studies designed to improve the health of late preterm infants who account for 8% of all infants born in the US each year - through additional prospective research or interventions. It will provide the training and experience necessary for Dr. Halloran to become an independent investigator in infant outcomes research.

描述（由申请人提供）：总结超过70%的早产儿出生在妊娠34至36周或晚期早产。这相当于美国每年出生婴儿的8%。这些婴儿在围产期发病和死亡的风险增加，在出生后第一年死亡的可能性增加一倍。尽管如此，只有初步的研究已经完成，以探讨这些婴儿在生命的第一年的发病率。过度假设：晚期早产儿在围产期后发病的风险增加。具体目标1：使用与出生证明记录相关的私人和公共行政索赔数据，描述社会人口学多样化人群中晚期早产的发生率和风险因素。假设：种族和社会经济地位是晚期早产的独立危险因素。Halloran博士将把出生证明记录与私人和公共保险索赔数据联系起来。她将描述一个种族和经济多样化的群体中晚期早产的发病率和风险因素，以增加对晚期早产定义不充分的流行病学的理解。具体目标二：评估晚期早产儿和足月儿在出生后第一年内的病因特异性和孕龄特异性发病率，特别是与分娩相关的疾病。假设：与足月儿相比，晚期早产儿有呼吸系统诊断、麻醉相关药物使用和麻醉相关住院的可能性是足月儿的两倍。Halloran博士将描述胎龄与呼吸系统并发症的相关性，包括早产相关诊断、住院/门诊医疗保健利用以及晚期早产儿与足月儿的药物使用。具体目标3：使用基于人口的数据，包括与出生证明记录相关的私人和公共索赔数据，确定晚期早产儿与足月儿在出生后第一年的婴儿护理成本差异。假设：与足月儿相比，晚期早产儿在出生后第一年的总护理费用至少增加100%。Halloran博士将检查晚期早产儿与足月儿在整个生命的第一年的总成本（住院，门诊和处方药）和系统特定成本。Halloran博士获得公共卫生研究奖学金和科学硕士学位后，正在圣路易斯大学（SLU）普通儿科学系攻读终身教职。她选择了一个多学科的导师小组，他们在母胎医学、生殖医学、卫生服务研究、卫生经济学和生物统计学方面具有专业知识和经验。该委员会与SLU医学院，SLU公共卫生学院和华盛顿大学临床与转化科学研究所的支持相结合，将为她提供强大的研究环境。通过高级统计培训作为成果研究博士学位的一部分，以及一个多元化，经验丰富的导师和顾问团队的指导，Halloran博士将有能力成为婴儿成果研究的独立研究者。 公共卫生关系：这一建议将导致开发一个基于风险的系统，对晚期早产儿的异质类别进行细分，并提高该人群风险评估的精度。该项目将为未来的研究奠定基础，这些研究旨在通过额外的前瞻性研究或干预措施来改善占美国每年出生婴儿总数8%的晚期早产儿的健康状况。它将为Halloran博士成为婴儿结局研究的独立研究者提供必要的培训和经验。