PEDIATRICS Vol. 91 No. 2 February 1993, pp. 464-469
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Neonatal Intensive Care and Birth Weight-Specific Perinatal Mortality in Michigan and Lorraine

Embry Martin Howell PhD1 and Paul Vert MD2

1 From Mathemafica Policy Research, Washington, DC
2 From University of Nancy, France

This study investigated the factors influencing use of neonatal intensive care and perinatal mortality in regions of the United States and France, two countries with similar health care systems but different approaches to health financing. The study employed birth certificates from Michigan and a birth registry from Lorraine in 1984. The study showed that geographic access and socioeconomic status were important in determining use of neonatal intensive care in both regions. Socioeconomic factors in perinatal mortality were also shown for both regions, after controlling for gestational age, birth weight, and neonatal intensive care use. In Michigan, infants of mothers with low education had higher mortality rates and in Lorraine residents of low income areas had higher mortality rates. A higher proportion of Michigan women delivered in hospitals with neonatal intensive care than in Lorraine, in all weight/gestation categories. Perinatal mortality rates were also lower in Michigan than in Lorraine, overall and within birth weight categories.

Key Words: perinatal mortality • United States • France • neonatal intensive care • birth outcomes

Submitted on July 24, 1992
Accepted on October 6, 1992




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