Costs of preterm birth in culturally and linguistically diverse children in Australia: a data linkage study 

Background: Culturally and linguistically diverse (CALD) women face a number of adversities in Australia in relation to accessing medical care. In particular, CALD women are at an increased risk of adverse pregnancy and birth outcomes including prematurity and low birthweight. Prematurity (before 37 weeks gestation) is associated with morbidities such as behavioural, developmental, and physical conditions including long-term chronic diseases. This paper seeks to identify to difference in health service use, health events and outcomes, and costs of CALD premature infants compared to term CALD infants. Methods: An existing linked administrative dataset, Maternity1000 was utilized for this study which has identified all children born in Queensland (QLD), Australia, between 1 st July 2012 to 30 th June 2018 from the QLD Perinatal Data Collection. This has then been linked to the QLD Hospital Admitted Patient Data Collection, QLD Hospital Non-Admitted Patient Data Collection, QLD Emergency Department Data Collection, and Medicare Benefits Schedule and Pharmaceutical Benefits Scheme Claims Records between 1 July 2012 to 30 th June 2019. Costs per year from birth to five years will also be calculated and will be presented in 2020/2021 Australian dollars. Findings: Overall, preterm CALD infants had higher rates of health service use potentially preventable hospitalisations (8·97% vs 7·60%), ED presentations without admissions (30·02% vs 25·03%), special care nursery/NICU admission (70·6% vs 12·22%), and development of chronic conditions (14·05% vs 9·4%). In total, costs of preterm CALD infants were 134·01 times higher for public hospital funders, 341·54 times higher for private health insurers, and 204·16 times higher for out-of-pocket costs than term CALD infants. Interpretation The costs associated with the care of a premature CALD infant are higher in the first year of life, and consistently higher through to age five in comparison to a term CALD infant Funding EC receives salary support from an NHMRC Career Development Fellowship, this work was also supported by a Ferring Pharmaceuticals Innovation Grant.