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Open Access Research article

Neonatal outcomes after preterm birth by mothers’ health insurance status at birth: a retrospective cohort study

Kristjana Einarsdóttir1*, Fatima A Haggar2, Amanda T Langridge1, Anthony S Gunnell3, Helen Leonard1 and Fiona J Stanley1

Author affiliations

1 Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, 100 Roberts Road, Subiaco, WA, 6008, Australia

2 Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway Crawley, Perth, WA, 6009, Australia

3 Health and Wellness Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia

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Citation and License

BMC Health Services Research 2013, 13:40  doi:10.1186/1472-6963-13-40

Published: 4 February 2013

Abstract

Background

Publicly insured women usually have a different demographic background to privately insured women, which is related to poor neonatal outcomes after birth. Given the difference in nature and risk of preterm versus term births, it would be important to compare adverse neonatal outcomes after preterm birth between these groups of women after eliminating the demographic differences between the groups.

Methods

The study population included 3085 publicly insured and 3380 privately insured, singleton, preterm deliveries (32–36 weeks gestation) from Western Australia during 1998–2008. From the study population, 1016 publicly insured women were matched with 1016 privately insured women according to the propensity score of maternal demographic characteristics and pre-existing medical conditions. Neonatal outcomes were compared in the propensity score matched cohorts using conditional log-binomial regression, adjusted for antenatal risk factors. Outcomes included Apgar scores less than 7 at five minutes after birth, time until establishment of unassisted breathing (>1 minute), neonatal resuscitation (endotracheal intubation or external cardiac massage) and admission to a neonatal special care unit.

Results

Compared with infants of privately insured women, infants of publicly insured women were more likely to receive a low Apgar score (ARR = 2.63, 95% CI = 1.06-6.52) and take longer to establish unassisted breathing (ARR = 1.61, 95% CI = 1.25-2.07), yet, they were less likely to be admitted to a special care unit (ARR = 0.84, 95% CI = 0.80-0.87). No significant differences were evident in neonatal resuscitation between the groups (ARR = 1.20, 95% CI = 0.54-2.67).

Conclusions

The underlying reasons for the lower rate of special care admissions in infants of publicly insured women compared with privately insured women despite the higher rate of low Apgar scores is yet to be determined. Future research is warranted in order to clarify the meaning of our findings for future obstetric care and whether more equitable use of paediatric services should be recommended.

Keywords:
Health insurance; Preterm birth; Neonatal outcomes; Apgar score; Neonatal resuscitation