5 years ago

Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis

Nicole Adams, David Tudehope, Vicki Flenady, Kristen S. Gibbons
Objective To examine whether disparities in stillbirth, neonatal and perinatal mortality rates between public and private hospitals are due to differences in population characteristics and/or clinical practices. Design Retrospective cohort study. Setting A metropolitan tertiary centre encompassing public and private hospitals. Women accessed care from either a private obstetrician or public models of care – predominantly midwife-led or care shared between midwives, general practitioners and obstetricians. Population 131 436 births during 1998–2013; 69 037 public and 62 399 private. Materials and methods Propensity score matching was used to select equal-sized public and private cohorts with similar characteristics. Logistic regression analysis was then used to explore the impact of public-private differences in use of assisted reproductive technologies, plurality, major congenital anomalies, birth method and gestational age. Main outcome measures Stillbirth, neonatal and perinatal mortality rates. Results After controlling for maternal and pregnancy factors, perinatal mortality rates were higher in the public than the private cohort (adjusted OR [AOR] 1.53, 95% CI 1.29–1.80; stillbirth AOR 1.56, 95% CI 1.26–1.94; neonatal death AOR 1.48, 95% CI 1.15–1.89). These disparities reduced by 15.7%, 20.5% and 19.6% respectively after adjusting for major congenital anomalies, birth method and gestational age. Conclusion Perinatal mortality occurred more often among public than private births and this disparity was not explained by population differences. Differences in clinical practices seem to be partly responsible. The impact of differences in clinical practices on maternal and neonatal morbidity was not examined. Further research is required. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/1471-0528.14903

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