Abstract：
BACKGROUND: Intraventricular hemorrhage (IVH) often affects newborns of low gestational age and low birth weight, requires critical care for neonates, and is linked to long-term neurodevelopmental outcomes. Assessing regional differences in the U.S. in care for neonatal IVH and subsequent outcomes can shed light on ways to mitigate socioeconomic disparities.
METHODS: Using the 2016-2019 National Inpatient Sample (NIS), patients with a primary diagnosis of IVH were identified using ICD-10-CM codes. A retrospective cohort study was conducted with patients stratified by hospital region. Demographics, comorbidities, presentation, intraoperative variables, and inpatient outcomes were assessed. Multivariate logistic regression analyses were used to identify the impact of insurance status on extended LOS (defined as > 75th percentile of LOS), exorbitant cost (defined as > 75th percentile of cost), and mortality.
RESULTS: Included in this study were 1630 newborns with IVH. A larger portion of patients in the South and Midwest were Black, compared to the Northeast and West (Northeast: 12.2% vs Midwest: 30.2% vs South: 22.8% vs West: 5.8%, p < 0.001), while a greater percentage of patients in the West and South were Hispanic (Northeast: 7.3% vs Midwest: 9.5% vs South: 22.8% vs West: 36.2%, p < 0.001). LOS was similar among all regions. Factors associated with prolonged LOS included hydrocephalus and CSF diversions. Median total cost of admission was highest in the West, while the South was associated with decreased odds of exorbitant cost. LOS was associated with exorbitant cost, and large bed-volume hospital, VLBW, and permanent CSF shunt were associated with mortality.
CONCLUSIONS: Demographic variables, but not presenting or intraoperative variables, differed among regions, pointing to possible geographic health disparities. The West had the highest total cost of admission, while the South was associated with reduced odds of exorbitant admission costs.
METHODS: Using the 2016-2019 National Inpatient Sample (NIS), patients with a primary diagnosis of IVH were identified using ICD-10-CM codes. A retrospective cohort study was conducted with patients stratified by hospital region. Demographics, comorbidities, presentation, intraoperative variables, and inpatient outcomes were assessed. Multivariate logistic regression analyses were used to identify the impact of insurance status on extended LOS (defined as > 75th percentile of LOS), exorbitant cost (defined as > 75th percentile of cost), and mortality.
RESULTS: Included in this study were 1630 newborns with IVH. A larger portion of patients in the South and Midwest were Black, compared to the Northeast and West (Northeast: 12.2% vs Midwest: 30.2% vs South: 22.8% vs West: 5.8%, p < 0.001), while a greater percentage of patients in the West and South were Hispanic (Northeast: 7.3% vs Midwest: 9.5% vs South: 22.8% vs West: 36.2%, p < 0.001). LOS was similar among all regions. Factors associated with prolonged LOS included hydrocephalus and CSF diversions. Median total cost of admission was highest in the West, while the South was associated with decreased odds of exorbitant cost. LOS was associated with exorbitant cost, and large bed-volume hospital, VLBW, and permanent CSF shunt were associated with mortality.
CONCLUSIONS: Demographic variables, but not presenting or intraoperative variables, differed among regions, pointing to possible geographic health disparities. The West had the highest total cost of admission, while the South was associated with reduced odds of exorbitant admission costs.
摘要：
背景：脑室内出血（IVH）通常会影响低胎龄和低出生体重的新生儿，需要对新生儿进行重症监护,并与长期神经发育结果有关。评估美国在新生儿IVH护理和后续结局方面的地区差异可以揭示减轻社会经济差异的方法。
方法：使用2016-2019年全国住院患者样本（NIS），主要诊断为IVH的患者使用ICD-10-CM编码进行鉴定.对按医院地区分层的患者进行了回顾性队列研究。人口统计,合并症,介绍,术中变量，并评估了住院患者的预后.多变量逻辑回归分析用于确定保险状况对延长的LOS（定义为>LOS的第75百分位数）的影响，过高的成本(定义为>成本的第75百分位数)，和死亡率。
结果：本研究包括1630例IVH新生儿。南部和中西部的大部分患者是黑人，与东北和西部相比（东北：12.2％vs中西部：30.2％vs南部：22.8％vs西部：5.8％，p<0.001)，而西部和南部的患者比例更高（东北：7.3％vs中西部：9.5％vs南部：22.8％vs西部：36.2％，p<0.001)。所有地区的LOS相似。与LOS延长相关的因素包括脑积水和CSF转移。入学总成本中位数在西方最高，而南方与高昂成本的可能性降低有关。LOS与高昂的成本有关，和大床位医院，VLBW,永久性CSF分流术与死亡率相关.
结论：人口统计学变量，但不呈现或术中变量，各地区不同，指出可能的地理健康差异。西方的总入场费最高，而南方与高昂的入院费用的几率降低有关。
方法：使用2016-2019年全国住院患者样本（NIS），主要诊断为IVH的患者使用ICD-10-CM编码进行鉴定.对按医院地区分层的患者进行了回顾性队列研究。人口统计,合并症,介绍,术中变量，并评估了住院患者的预后.多变量逻辑回归分析用于确定保险状况对延长的LOS（定义为>LOS的第75百分位数）的影响，过高的成本(定义为>成本的第75百分位数)，和死亡率。
结果：本研究包括1630例IVH新生儿。南部和中西部的大部分患者是黑人，与东北和西部相比（东北：12.2％vs中西部：30.2％vs南部：22.8％vs西部：5.8％，p<0.001)，而西部和南部的患者比例更高（东北：7.3％vs中西部：9.5％vs南部：22.8％vs西部：36.2％，p<0.001)。所有地区的LOS相似。与LOS延长相关的因素包括脑积水和CSF转移。入学总成本中位数在西方最高，而南方与高昂成本的可能性降低有关。LOS与高昂的成本有关，和大床位医院，VLBW,永久性CSF分流术与死亡率相关.
结论：人口统计学变量，但不呈现或术中变量，各地区不同，指出可能的地理健康差异。西方的总入场费最高，而南方与高昂的入院费用的几率降低有关。
