Absence of neonatal intensive care units in secondary medical care zones is an independent risk factor of high perinatal mortality in Japan.
OBJECTIVE
National medical projects are carried out according to medical care plans directed by the Medical Care Act of Japan. In order to improve Japanese perinatal medical care, it is necessary to determine the factors that might influence perinatal outcome.


METHODS
Statistical data of births and perinatal deaths were obtained for all municipalities in Japan from 2008 to 2012 from the Portal Site of Official Statistics of Japan (e-Stat). The perinatal mortality of all 349 Japanese secondary medical care zones was calculated. The number of neonatal intensive care units (NICUs), maternal-fetal intensive care units (MFICUs), pediatricians and obstetricians in 2011 were also obtained from e-Stat. Nine secondary medical care zones in two prefectures, Fukushima (7) and Miyagi (2) were excluded to eliminate the influence of the 2011 Great East Japan Earthquake.


RESULTS
The 340 secondary medical care zones were divided into three groups according to population size and density: metropolis, provincial city, and depopulation. The number of secondary medical care zones in each group were 52, 168, and 120, respectively. The secondary medical care zones in the depopulation group had fewer pediatricians and significantly fewer NICUs and MFICUs than the metropolis group, but there was no significant difference in perinatal mortality. The only independent risk factor for high perinatal mortality, determined by multivariable analysis, was the absence of an NICU (P = 0.011).


CONCLUSIONS
To consider directions in perinatal medical care, planned arrangement and appropriate access to NICUs is indispensable.
Medical Care Planning Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, Chiyoda-ku, Tokyo, Japan. yokomatsumoto@mac.com.|Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. yokomatsumoto@mac.com.
Yoko
Y
Matsumoto
Department of Obstetrics and Gynecology, Tama-Nagayama Hospital, Nippon Medical School, Tokyo, Japan.
Akihito
A
Nakai
Division of the Health for the Elderly, Ministry of Health, Labour and Welfare, Chiyoda-ku, Tokyo, Japan.
Yasuhiro
Y
Nishijima
Medical Care Planning Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, Chiyoda-ku, Tokyo, Japan.
Eisaku
E
Kishita
Medical Care Planning Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, Chiyoda-ku, Tokyo, Japan.
Haruhiko
H
Hakuno
Medical Care Planning Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, Chiyoda-ku, Tokyo, Japan.
Masami
M
Sakoi
Department of Neonatology, Maternal And Perinatal Center of Tokyo Women's Medical University, Shinjuku, Tokyo, Japan.
Satoshi
S
Kusuda
Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Minami-ku, Sagamihara city, Japan.
Nobuya
N
Unno
Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
Masanori
M
Tamura
Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Tomoyuki
T
Fujii
D001723:Birth Rate; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007564:Japan / Q000453:epidemiology; D054238:Perinatal Mortality; D012307:Risk Factors; D000078329:Workforce
Health policy; intensive care unit; neonatal (NICU); perinatal care; perinatal mortality; vital statistics