Objective:
To evaluate the relationship between prenatal and postnatal inflammation-related risk factors and severe retinopathy of prematurity (ROP).
Study Design:
The study included infants born <30 weeks in California from 2007–2011. Multivariable log binomial regression was used to assess the association between prenatal and postnatal inflammation-related exposures and severe ROP, defined as stage 3–5 or surgery for ROP.
Results:
Of 14,816 infants, 10.8% developed severe ROP. Though prenatal inflammation-related risk factors were initially associated with severe ROP, after accounting for the effect of these risk factors on gestational age at birth through mediation analysis, the association was non-significant (P=0.6). Postnatal factors associated with severe ROP included prolonged oxygen exposure, sepsis, intraventricular hemorrhage, and necrotizing enterocolitis.
Conclusion:
Postnatal inflammation-related factors were associated with severe ROP more strongly than prenatal factors. The association between prenatal inflammation-related factors and ROP was explained by earlier gestational age in infants exposed to prenatal inflammation.
Background
In the United States, the mortality rate from traffic injury is higher in rural and in southern regions, for reasons that are not well understood.
Methods
For 1754 (56%) of the 3142 US counties, we obtained data allowing for separation of the deaths/population (D/P) rate into deaths/injury (D/I), injuries/crash (I/C), crashes/exposure (C/E), and exposure/population (E/P), with exposure measured as vehicle miles traveled. A “decomposition method” proposed by Li and Baker was extended to study how the contributions of these components were affected by three measures of rural location, as well as southern location.
Results
The method of Li and Baker extended without difficulty to include non-binary effects and multiple exposures. D/I was by far the most important determinant in the county-to-county variation in D/P, and accounted for the greatest portion of the rural/urban disparity. After controlling for the rural effect, I/C accounted for most of the southern/northern disparity.
Conclusions
The increased mortality rate from traffic injury in rural areas can be attributed to the increased probability of death given that a person has been injured, possibly due to challenges faced by emergency medical response systems. In southern areas, there is an increased probability of injury given that a person has crashed, possibly due to differences in vehicle, road, or driving conditions.
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