title: Time trends and risk factor associated with premature birth and infants deaths due to prematurity in Hubei Province, China from 2001 to 2012.
abstract: BACKGROUND
  The nutrition and epidemiologic transition has been associated with an increasing incidence of preterm birth in developing countries, but data from large observational studies in China have been limited. Our study was to describe the trends and factors associated with the incidence of preterm birth and infant mortality due to prematurity in Hubei Province, China.
  
  
  METHODS
  We conducted a population-based survey through the Maternal and Child Health Care Network in Hubei Province from January 2001 to December 2012. We used data from 16 monitoring sites to examine the trend and risk factors for premature birth as well as infant mortality associated with prematurity.
  
  
  RESULTS
  A total of 818,481 live births were documented, including 76,923 preterm infants (94 preterm infants per 1,000 live births) and 2,248 deaths due to prematurity (2.75 preterm deaths per 1,000 live births). From 2001 to 2012, the incidence of preterm birth increased from 56.7 to 105.2 per 1,000 live births (P for trend < 0.05), while the infant mortality rate due to prematurity declined from 95.0 to 13.4 per 1,000 live births (P for trend < 0.05). Older maternal age, lower maternal education, use of assisted reproductive technology (ART), higher income, residence in urban areas, and infant male sex were independently associated with a higher incidence of preterm birth (all p values < 0.05). Shorter gestation, lower birth weight, and lower income were associated with a higher mortality rate, while use of newborn emergency transport services (NETS) was associated with a lower preterm mortality rate (all p values < 0.05).
  
  
  CONCLUSIONS
  An increasing incidence of preterm birth and a parallel reduction in infant mortality due to prematurity were observed in Hubei Province from 2001 to 2012. Our results provide important information for areas of improvements in reducing incidence and mortality of premature birth.
authors.affiliation: Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China. xuhaiqing9@126.com.
authors.forename: Haiqing
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China. daiqiong74@163.com.
authors.forename: Qiong
authors.initials: Q
authors.lastname: Dai
authors.affiliation: Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China. hwxys@hotmail.com.
authors.forename: Yusong
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China. gongzhengtao@hotmail.com.
authors.forename: Zhengtao
authors.initials: Z
authors.lastname: Gong
authors.affiliation: Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China. hbfyxmb@163.net.
authors.forename: Guohong
authors.initials: G
authors.lastname: Dai
authors.affiliation: Department of Nutrition, Harvard School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA. mid829@mail.harvard.edu.
authors.forename: Ming
authors.initials: M
authors.lastname: Ding
authors.affiliation: Department of Nutrition, Harvard School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA. christopher.duggan@childrens.harvard.edu.|Boston Children's Hospita, Boston, Massachusetts, USA. christopher.duggan@childrens.harvard.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.affiliation: Department of Child Health Care, Hubei Maternal and Child Health Hospital, Wuhan, China. huzubin@hotmail.com.
authors.forename: Zubin
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Department of Nutrition, Harvard School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA. nhbfh@channing.harvard.edu.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
mesh_terms: D000328:Adult; D001724:Birth Weight; D002681:China / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D005544:Forecasting; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D011247:Pregnancy; D011272:Pregnancy, Multiple; D047928:Premature Birth / Q000453:epidemiology*; D027724:Reproductive Techniques, Assisted; D012307:Risk Factors