The Cost of Prematurity

November 22, 2010

In 2006, there were 4.3 million children born in the United States. Approximately 55,000 of those children were born prematurely. Premature births have been increasing consistently since 1990 (though there appears to have been a slight drop in the rate of prematurity in 2007). In 1990, 10.6 percent of children were born prematurely; in 2006, that percentage had increased to 12.8 (preliminary numbers show a 12.6 percent rate in 2007 – still considerably higher than the rate in 1990). Last week, our center released an issue brief on this topic because we think it is such an important issue.

Why are premature births important? First and foremost, children who are born prematurely are at much greater risk for health problems than are children born at full term. The impact on families and the children themselves is enormous. In 2006, prematurity/low birth weight was the single largest cause of infant mortality in Michigan. In addition to being at higher risk for infant mortality, children who are born prematurely are at greater risk of developmental and behavioral problems later in childhood – problems that have a significant impact not just on the children themselves but also on families, schools, and the broader community.

Second, preterm births are costly. In 2007, the average charge for a premature birth/low birth weight delivery was $102,000 in Michigan ($119,000 in the U.S.), approximately 14 times higher than the average charge for a normal delivery. And, the cost differential continues in the first year of life. Average first year costs for preterm children in 2008/9 for Blue Cross and Blue Shield of Michigan (BCBSM) were $41,700 compared to $4,300 for children born at full term. Children born preterm with BCBSM coverage represented 10.3 percent of total births but accounted for 52.6 percent of total spending for all children in the first year of life.

Preterm births are not evenly distributed across the population. Black infants are 70 percent more likely to be born preterm than are white infants. And, prematurity is significantly more deadly for black infants than it is for white infants. In 2006, 5.6 percent of white infants in the U.S. died, about one third of those related to prematurity. In that same time period, 13.4 percent of black infants died with almost half due to prematurity.

And the extra tragedy is: we really don’t know why. We know that certain prematurity related risk factors (smoking, teen mothers) are more likely to occur with black mothers than whites, but even adjusting for these differences does not explain the disparity. Other theories have been posed but none have fully explained this difference or provided good guideposts on how to change this picture. And, children will keep dying or living compromised lives until we understand what is going on here.

Prematurity is unquestionably an area where we need further research to understand the causes and to develop more effective interventions to make a difference. Good research here could help save lives; improve the quality of lives of our children; reduce the burdens on our schools and communities who must deal with the longer term effects of prematurity; and, save significant dollars in the health care system and elsewhere in society. This is truly what public health is all about. So, let’s hope that with all the innovations and research being funded through the Affordable Care Act, particularly with the significant funding provided in the Prevention and Public Health Fund, the issues surrounding prematurity become a priority. After all, we are talking about our children and our future. What could be more important?