title: Population attributable risks of patient, child and organizational risk factors for perinatal mortality in hospital births.
abstract: The main objective of this study was to estimate the contributing role of maternal, child, and organizational risk factors in perinatal mortality by calculating their population attributable risks (PAR). The primary dataset comprised 1,020,749 singleton hospital births from ≥22 weeks' gestation (The Netherlands Perinatal Registry 2000-2008). PARs for single and grouped risk factors were estimated in four stages: (1) creating a duplicate dataset for each PAR analysis in which risk factors of interest were set to the most favorable value (e.g., all women assigned 'Western' for PAR calculation of ethnicity); (2) in the primary dataset an elaborate multilevel logistic regression model was fitted from which (3) the obtained coefficients were used to predict perinatal mortality in each duplicate dataset; (4) PARs were then estimated as the proportional change of predicted- compared to observed perinatal mortality. Additionally, PARs for grouped risk factors were estimated by using sequential values in two orders: after PAR estimation of grouped maternal risk factors, the resulting PARs for grouped child, and grouped organizational factors were estimated, and vice versa. The combined PAR of maternal, child and organizational factors is 94.4 %, i.e., when all factors are set to the most favorable value perinatal mortality is expected to be reduced with 94.4 %. Depending on the order of analysis, the PAR of maternal risk factors varies from 1.4 to 13.1 %, and for child- and organizational factors 58.7-74.0 and 7.3-34.3 %, respectively. In conclusion, the PAR of maternal-, child- and organizational factors combined is 94.4 %. Optimization of organizational factors may achieve a 34.3 % decrease in perinatal mortality.
authors: Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynecology, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands, v.j.j.poeran@gmail.com.
authors: Jashvant
authors: J
authors: Poeran
authors: Gerard J J M
authors: GJ
authors: Borsboom
authors: Johanna P
authors: JP
authors: de Graaf
authors: Erwin
authors: E
authors: Birnie
authors: Eric A P
authors: EA
authors: Steegers
authors: Gouke J
authors: GJ
authors: Bonsel
mesh_terms: D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D009426:Netherlands / Q000453:epidemiology; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D010298:Parity; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult