Sociodemographic Factors Associated With Weekend Birth and Increased Risk of Neonatal Mortality

doi:10.1111/j.1552-6909.2006.00034.x

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 35, Issue 2, March–April 2006, Pages 208-214

https://doi.org/10.1111/j.1552-6909.2006.00034.x Get rights and content

Objective

To learn whether weekend risk of neonatal mortality is related to selected sociodemographic factors.

Design

A retrospective cohort design. Logistic regression was used to obtain odds ratios, and analysis of variance and chi‐square to identify differences in values and incidence of key variables.

Samples

The data were derived from matched Texas birth and infant death certificates from 1999 through 2001.

Main outcome measures

A subset of deaths up to 28 days of life attributable to conditions originating in the perinatal period. These deaths were called neonatal mortality‐p.

Results

Women who were White, married, had Medicaid assistance, and had private prenatal care were less likely to deliver on weekends. Odds of neonatal mortality‐p increased 36.5% when a birth took place on the weekend. The weekend crude odds of neonatal mortality‐p increased for all racial/ethnic groups, but the differences were not statistically significant.

Conclusions

The likelihood of delivering on the weekend increases with certain sociodemographic factors. This fact is important because the risk of neonatal mortality is higher among weekend births. JOGNN, 35, 208‐214; 2006. DOI: 10.1111/J.1552‐6909.2006.00034.x.

Section snippets

Literature review

Bell and Redelmeier (2001) reported that patients with ruptured aortic aneurysm, acute epiglottitis, and pulmonary embolism were more likely to die in the hospital, if they were admitted on a weekend than those admitted during the week. The findings held after adjusting for age, sex, and comorbidities. Weekend admission was also associated with significantly higher mortality among 23 of the 100 conditions that were the most common causes of death in their sample of 3,789,917 admissions from

Method

For the purpose of determining whether sociodemographic factors in addition to race/ethnicity might be related to weekend risk, a retrospective cohort study was conducted using matched birth and death certificates in an adult cohort (more than 19 years old) in Texas from 1999 through 2001 (N= 923,905). The following questions were asked:

1
Is there an association between race/ethnicity, marital status, Medicaid assistance, or source of prenatal care and likelihood of weekend delivery?
2
Are there

Results

Question 1. Is there an association between race/ethnicity, marital status and receiving Medicaid, and private prenatal care and likelihood of weekend delivery?

Minority women who were unmarried, did not receive private prenatal care, and did not receive Medicaid were more likely to give birth on weekends.

Chi‐square tests of independence were conducted to determine whether there was an association between key demographic factors and increased likelihood of weekend birth. There was a

Discussion

The sociodemographic factors examined, race/ethnicity, marital status, Medicaid assistance, and source of prenatal care, were each associated with likelihood of weekend birth and its accompanying increased odds of neonatal mortality‐p. Women who were members of a racial/ethnic minority, were unmarried, received no Medicaid assistance, and received nonprivate prenatal care, all had increased likelihood of delivering on the weekend. Weekends were the time of the fewest births but with the highest

Implications for nursing

Applying the reasoning of Rindfuss et al. (1979), high‐risk and unscheduled deliveries on weekends should be handled by a staff equipped to deal with serious complications. Because volume is lower on weekends, staffing may not be at optimal nurse/patient ratios or at expertise levels that match the potential acuity of the case mix. It is not enough, though, to simply be prepared for the worst on weekends. Nurses also need to determine why differences in the likelihood of weekend delivery exist

Acknowledgment

Supported by Texas Woman's University Research Enhancement Program.

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There are more references available in the full text version of this article.

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Citation Excerpt :
However, these findings have not been consistent in all studies.8 Greater severity or a possible decrease in the quality of care during the weekends have been suggested as possible causative factors.9–11 This effect may also be due to the selective effect of obstetrical intervention during delivery.6,12
To know the distribution of births of very low birth weight infants by day of the week, and whether this distribution affects the morbidity and mortality in this group of patients.
This was a retrospective analysis of data collected prospectively in the Spanish SEN1500 network (2002–2011). Outborn infants, patients with major congenital anomalies, and those who died in the delivery room were excluded. Births were grouped into “weekdays” and “weekends.” A multivariate logistic regression analysis was conducted to evaluate the independent effect of the birth moment on outcomes, and Cox regression for survival.
Out of a total of 27,205 very low birth weight infants born at and/or admitted to the participating centers, 22,961 (84.4%) met inclusion criteria. A reduction of 24% in the number of births was observed during the “weekends” compared with “weekdays”. In the raw analysis, patients born on weekends exhibited higher morbidity and mortality (mortality rate: 14.2% vs. 16.5%, p < 0.001), but differences were no longer significant after adjusting for confounding factors.
The present results suggest that current care practices reduce the proportion of births during the weekends and tend to cluster some high-risk births during this period, increasing crude morbidity and mortality. However, after adjusting for confounding factors, the differences disappear, suggesting that overall care coverage in these centers is appropriate.
Conhecer a distribuição dos partos de neonatos com muito baixo peso ao nascer durante a semana e se essa distribuição afeta a morbidez e a mortalidade nesse grupo de pacientes.
Esta é uma análise retrospectiva de dados coletados prospectivamente na rede espanhola SEN1500 (2002-2011). Foram excluídos neonatos nascidos em outro local, pacientes com grandes anomalias congênitas e pacientes falecidos na sala de parto. Os partos foram agrupados em “Dias úteis” e “Final de semana”. Foi realizada uma análise de regressão logística multivariada para avaliar o efeito independente do parto sobre os resultados e uma regressão de Cox para avaliar a sobrevida.
Do total de 27.205 neonatos com muito baixo peso ao nascer nascidos e/ou internados nos centros participantes, 22.961 (84,4%) atenderam aos critérios de inclusão. Houve uma redução de 24% no número de partos no “Final de semana” em comparação aos “Dias úteis”. Na análise bruta, os pacientes nascidos em finais de semana apresentaram maior morbidez e mortalidade (Taxa de mortalidade: 14,2% em comparação a 16,5%, p < 0,001), porém as diferenças não eram mais significativas após o ajuste aos fatores de confusão.
Nossos resultados sugerem que as práticas atuais de atendimento reduzem a proporção de partos em finais de semana e tendem a agrupar alguns partos de alto risco nesse período, aumentando a morbidez e mortalidade brutas. Contudo, após o ajuste aos fatores de risco, as diferenças desaparecem, sugerindo que a cobertura de atendimento geral em nossos centros é adequada.
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Magnitude and modifiers of the weekend effect in hospital admissions: A systematic review and meta-analysis
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Relationships Among Neonatal Mortality, Hospital Volume, Weekday Demand, and Weekend Birth
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CLINICAL RESEARCHSociodemographic Factors Associated With Weekend Birth and Increased Risk of Neonatal Mortality

Objective

Design

Samples

Main outcome measures

Results

Conclusions

Section snippets

Literature review

Method

Results

Discussion

Implications for nursing

Acknowledgment

Journal of Obstetric, Gynecologic and Neonatal Nursing

Mortality among patients admitted to hospitals on weekends as compared with week‐days

New England Journal of Medicine

Confidential enquiry into stillbirth and deaths in infancy

Neonatal mortality in weekend versus weekday births

Journal of the American Medical Association

The weekend‐a dangerous time to be born?

British Journal of Obstetrics and Gynaecology

Joint commission appoints expert panel to help guide study of language, cultural issues in hospitals

Supplemental analysis of recent trends in infant mortality

CLINICAL RESEARCH
Sociodemographic Factors Associated With Weekend Birth and Increased Risk of Neonatal Mortality