Regional and practitioner variations in reporting infant mortality

Abstract

Objective

Assess regional differences in categorization of preterm delivery outcomes and impact on variation in reported infant mortality rates.

Study design

A 27-item questionnaire was distributed to 1072 practitioners associated with U.S. birth hospitals. Five clinical scenarios were created to identify how participants classify delivery outcomes. Statistical analysis included Chi-square analysis and multinomial logistic regression.

Results

234 questionnaires were completed (response rate 22%). While >90% respondents classified a 14-week pregnancy loss with no sign of life as a miscarriage, only 22% would provide a fetal death certificate. Likewise, 37% would provide a certificate of live birth for a loss at 16 weeks with signs of life. There was notable regional variation in classifying these as live births (Northeast: 41%, Midwest: 44%, South: 13%, and West: 18%, p = .003).

Conclusion

Regional practice variation in recording both live births and stillbirths was noted. Greater standardization in reporting practices may be warranted to improve the accuracy of reported birth outcomes in the U.S.

Keywords:

• Preterm birth
• infant mortality
• regional variation
• practitioner variation

Acknowledgments

The research team would like to thank the individuals who generously shared their time, experience, and opinions for the purposes of this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by NIH/CTSA CCTST Grant Number [5UL1TR001425-04]. The contents of the study are the responsibility of the authors and do not necessarily represent official NIH views. Dr. DeFranco received research funding from the Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and March of Dimes Prematurity Research Center Ohio Collaborative.