Bias in comparisons of mortality among very preterm births: A cohort study.

<h4>Background</h4>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 a...

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Autores principales:	Amélie Boutin, Sarka Lisonkova, Giulia M Muraca, Neda Razaz, Shiliang Liu, Michael S Kramer, K S Joseph
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c80ac61da7184381b4485aa2df2281af
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spelling	oai:doaj.org-article:c80ac61da7184381b4485aa2df2281af2021-12-02T20:15:41ZBias in comparisons of mortality among very preterm births: A cohort study.1932-620310.1371/journal.pone.0253931https://doaj.org/article/c80ac61da7184381b4485aa2df2281af2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253931https://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.Amélie BoutinSarka LisonkovaGiulia M MuracaNeda RazazShiliang LiuMichael S KramerK S JosephPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0253931 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Amélie Boutin Sarka Lisonkova Giulia M Muraca Neda Razaz Shiliang Liu Michael S Kramer K S Joseph Bias in comparisons of mortality among very preterm births: A cohort study.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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	article
author	Amélie Boutin Sarka Lisonkova Giulia M Muraca Neda Razaz Shiliang Liu Michael S Kramer K S Joseph
author_facet	Amélie Boutin Sarka Lisonkova Giulia M Muraca Neda Razaz Shiliang Liu Michael S Kramer K S Joseph
author_sort	Amélie Boutin
title	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_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_sort	bias in comparisons of mortality among very preterm births: a cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/c80ac61da7184381b4485aa2df2281af
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Bias in comparisons of mortality among very preterm births: A cohort study.

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