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

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周或晚期早产儿。这相当于美国每年出生的婴儿总数的8%。这些婴儿在围产期发病和死亡的风险更高，在出生后第一年死亡的可能性是前者的两倍。尽管如此，只有初步的研究来探讨这些婴儿在出生后第一年的发病率。总体假设：晚期早产儿在围产期后发病风险增加。具体目标1：利用与出生证明记录相关的私人和公共行政索赔数据，描述不同社会人口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。哈洛伦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。她将描述在种族和经济多样化的群体中晚期早产的发生率和危险因素，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2：评估晚期早产儿和足月儿出生后第一年的病因特异性和胎龄特异性发病率，特别是呼吸相关疾病。假设：与足月婴儿相比，晚期早产儿有呼吸系统诊断、呼吸相关药物使用和呼吸相关住院治疗的可能性是足月婴儿的两倍。Halloran博士将描述胎龄与呼吸系统并发症的关系，包括呼吸相关诊断、住院/门诊医疗保健的利用以及晚期早产儿与足月婴儿的药物使用。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婴儿在生命第一年的婴儿护理成本差异。假设：与足月婴儿相比，晚期早产儿在第一年的总护理费用至少增加了100%。Halloran博士将检查总成本（住院、门诊和处方药）以及晚期早产儿和足月婴儿在生命第一年的系统特异性成本。在获得公共卫生研究奖学金和科学硕士学位后，Halloran博士在圣路易斯大学（SLU）普通儿科学系获得终身教职。她选择了一个多学科的导师小组，他们在母胎医学、新生儿学、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，将为她提供一个强大的研究环境。作为结果研究博士学位的一部分，Halloran博士接受了高级统计培训，并在经验丰富的导师和顾问团队的指导下，将成为婴儿结果研究领域的独立研究者。

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.