In the Canadian population, does caesarean delivery compared to vaginal birth increase risk of early neonatal mortality? An instrumental variable method approach
Notice bibliographique
Résumé
BACKGROUND: The lack of adjustment for unmeasured factors which may be associated with both delivery decisions and pregnancy outcomes has likely resulted in an overestimation of the risk associated with caesarean delivery on neonatal mortality. An instrumental variable method (IVM) originating from the field of econometrics has been utilized in modern epidemiological research to reduce the influence of unmeasured selection bias. By accounting for measured, unmeasured, and unknown confounding variables, utilizing the IVM can serve as a more valid approach in determining intervention effects amongst patients in observational studies. OBJECTIVE: The purpose of this study is to compare the results from traditional multivariate methods and instrumental variable-adjusted analyses to determine if caesarean delivery increases the risk of early neonatal death in comparison to vaginal birth. MATERIALS AND METHODS: This is a retrospective cohort study which compares the outcome of early neonatal mortality between 20 completed weeks of gestation and 7 days post-partum among women who delivered through a caesarean section and women who delivered vaginally. The cohort includes all in-hospital births during the fiscal years of April 1, 2006 - March 31, 2009 across Canada identified in the Discharge Abstract Database (DAD) from the Canadian Institute of Health Information (CIHI), excluding deliveries in Quebec. The effect of mode of delivery, being either caesarean or vaginal delivery, on early neonatal mortality was measured using a bivariate logistic regression, followed by a multivariate logistic regression and instrumental variable-adjusted analysis which controlled for 24 covariates. RESULTS: Multivariate logistic regression indicated that caesarean delivery significantly reduced the risk of early neonatal death in comparison to vaginal birth by 21% (Adjusted OR = 0.79, 95%CI = 0.66-0.93, p = 0.006). Instrumental variable-adjusted regression indicated a lack of association between mode of delivery and early neonatal mortality (ARD = -0.0053, 95%CI = -4.3x10⁻³-3.0x10⁻³, p = 0.781). CONCLUSION: In conclusion, the findings from the IVM analysis suggest that the risk of early neonatal mortality is not influenced by the mode of delivery. However, given the large discrepancy in risk estimates between analytic methods, health-system level recommendations towards altering local caesarean rates should be avoided until its impact on maternal and neonatal morbidities, hospital costs, and resulting factors are better understood. Future researchers should aim to answer these questions using similar analytic methods to help inform health-care policy makers and providers of the safety of caesarean deliveries.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,004 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».