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Bias in comparisons of mortality among very preterm births: A cohort study
BACKGROUND: Several studies of prenatal determinants and neonatal morbidity and mortality among very preterm births have resulted in unexpected and paradoxical findings. We aimed to compare perinatal death rates among cohorts of very preterm births (24–31 weeks) with rates among all births in these...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244917/ https://www.ncbi.nlm.nih.gov/pubmed/34191860 http://dx.doi.org/10.1371/journal.pone.0253931 |
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author | Boutin, Amélie Lisonkova, Sarka Muraca, Giulia M. Razaz, Neda Liu, Shiliang Kramer, Michael S. Joseph, K. S. |
author_facet | Boutin, Amélie Lisonkova, Sarka Muraca, Giulia M. Razaz, Neda Liu, Shiliang Kramer, Michael S. Joseph, K. S. |
author_sort | Boutin, Amélie |
collection | PubMed |
description | BACKGROUND: Several studies of prenatal determinants and neonatal morbidity and mortality among very preterm births have resulted in unexpected and paradoxical findings. We aimed to compare perinatal death rates among cohorts of very preterm births (24–31 weeks) with rates among all births in these groups (≥24 weeks), using births-based and fetuses-at-risk formulations. METHODS: We conducted a cohort study of singleton live births and stillbirths ≥24 weeks’ gestation using population-based data from the United States and Canada (2006–2015). We contrasted rates of perinatal death between women with or without hypertensive disorders, between maternal races, and between births in Canada vs the United States. RESULTS: Births-based perinatal death rates at 24–31 weeks were lower among hypertensive than among non-hypertensive women (rate ratio [RR] 0.67, 95% CI 0.65–0.68), among Black mothers compared with White mothers (RR 0.94, 95%CI 0.92–0.95) and among births in the United States compared with Canada (RR 0.74, 95%CI 0.71–0.75). However, overall (≥24 weeks) perinatal death rates were higher among births to hypertensive vs non-hypertensive women (RR 2.14, 95%CI 2.10–2.17), Black vs White mothers (RR 1.86, 95%CI 184–1.88;) and births in the United States vs Canada (RR 1.08, 95%CI 1.05–1.10), as were perinatal death rates based on fetuses-at-risk at 24–31 weeks (RR for hypertensive disorders: 2.58, 95%CI 2.53–2.63; RR for Black vs White ethnicity: 2.29, 95%CI 2.25–2.32; RR for United States vs Canada: 1.27, 95%CI 1.22–1.30). CONCLUSION: Studies of prenatal risk factors and between-centre or between-country comparisons of perinatal mortality bias causal inferences when restricted to truncated cohorts of very preterm births. |
format | Online Article Text |
id | pubmed-8244917 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-82449172021-07-12 Bias in comparisons of mortality among very preterm births: A cohort study Boutin, Amélie Lisonkova, Sarka Muraca, Giulia M. Razaz, Neda Liu, Shiliang Kramer, Michael S. Joseph, K. S. PLoS One Research Article BACKGROUND: Several studies of prenatal determinants and neonatal morbidity and mortality among very preterm births have resulted in unexpected and paradoxical findings. We aimed to compare perinatal death rates among cohorts of very preterm births (24–31 weeks) with rates among all births in these groups (≥24 weeks), using births-based and fetuses-at-risk formulations. METHODS: We conducted a cohort study of singleton live births and stillbirths ≥24 weeks’ gestation using population-based data from the United States and Canada (2006–2015). We contrasted rates of perinatal death between women with or without hypertensive disorders, between maternal races, and between births in Canada vs the United States. RESULTS: Births-based perinatal death rates at 24–31 weeks were lower among hypertensive than among non-hypertensive women (rate ratio [RR] 0.67, 95% CI 0.65–0.68), among Black mothers compared with White mothers (RR 0.94, 95%CI 0.92–0.95) and among births in the United States compared with Canada (RR 0.74, 95%CI 0.71–0.75). However, overall (≥24 weeks) perinatal death rates were higher among births to hypertensive vs non-hypertensive women (RR 2.14, 95%CI 2.10–2.17), Black vs White mothers (RR 1.86, 95%CI 184–1.88;) and births in the United States vs Canada (RR 1.08, 95%CI 1.05–1.10), as were perinatal death rates based on fetuses-at-risk at 24–31 weeks (RR for hypertensive disorders: 2.58, 95%CI 2.53–2.63; RR for Black vs White ethnicity: 2.29, 95%CI 2.25–2.32; RR for United States vs Canada: 1.27, 95%CI 1.22–1.30). CONCLUSION: Studies of prenatal risk factors and between-centre or between-country comparisons of perinatal mortality bias causal inferences when restricted to truncated cohorts of very preterm births. Public Library of Science 2021-06-30 /pmc/articles/PMC8244917/ /pubmed/34191860 http://dx.doi.org/10.1371/journal.pone.0253931 Text en © 2021 Boutin et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Boutin, Amélie Lisonkova, Sarka Muraca, Giulia M. Razaz, Neda Liu, Shiliang Kramer, Michael S. Joseph, K. S. Bias in comparisons of mortality among very preterm births: A cohort study |
title | Bias in comparisons of mortality among very preterm births: A cohort study |
title_full | Bias in comparisons of mortality among very preterm births: A cohort study |
title_fullStr | Bias in comparisons of mortality among very preterm births: A cohort study |
title_full_unstemmed | Bias in comparisons of mortality among very preterm births: A cohort study |
title_short | Bias in comparisons of mortality among very preterm births: A cohort study |
title_sort | bias in comparisons of mortality among very preterm births: a cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244917/ https://www.ncbi.nlm.nih.gov/pubmed/34191860 http://dx.doi.org/10.1371/journal.pone.0253931 |
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