Substantial Variability Between Traditional and Instrumental Variable Estimates of the Risk of Caesarean Section in Canada: a Population-based Cohort Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,703,590
- 主要终点
- Perinatal Mortality
研究概览
简要总结
This study will examine the effect of cesarean section on perinatal mortality, using data provided by the Canadian Institute for Health Information.
详细描述
This study will examine administrative data provided by the Canadian Institute for Health Information (CIHI). Maternal obstetrical delivery and neonatal hospitalization records provided by CIHI will be linked before analysis. The primary outcome is in-hospital perinatal mortality. The data will be analyzed by traditional multi-variate logistic regression, and the results from this analysis will be compared to the results from instrumental variable adjusted regression using the Generalized Method of Moments. The instrumental variable is the rate of cesarean delivery among women living within the same hospital catchment area. All analyses will be adjusted for maternal, infant, delivery provider, and hospital factors, as well as for clustering at the level of the delivery hospital.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Mothers living in Canada and their infants delivering within the study period at Canadian hospitals outside of the province of Quebec.
排除标准
- •Maternal record not linkable to neonatal record.
- •Multiple gestation.
- •Birthweight < 500 gm.
- •Gestational age at delivery < 20 weeks.
- •Deliveries at hospitals with less than 20 cesarean deliveries during study period.
- •Records with missing data for important covariates
结局指标
主要结局
Perinatal Mortality
时间窗: up to 7 days
Includes deaths at any age if infant continuously hospitalized (including transfers) in an acute care facility. Includes deaths up to 7 days of age if infant discharged from hospital then readmitted prior to 7 days of age.
次要结局
未报告次要终点
研究者
Kris Aubrey-Bassler
Director, Primary Healthcare Research Unit
Memorial University of Newfoundland