To examine the health care and hospitalizations of young children (birth to age 2 years) born to cocaine-using women and to assess the extent to which premature births account for differences between these children and comparison children.
A retrospective cohort design using a repeat-matching method: comparison children were matched to subjects with exposure to cocaine on 6 sociodemographic variables, first, without attention to gestational age and then using the gestational age as an additional matching variable.
City hospitals and primary care clinics.
Children of women giving birth at a single hospital.
Main Outcome Measures
Hospital admissions and indexes of health care use for children from birth to age 2 years.
Of the 139 subjects with exposure to cocaine, 23% were born prematurely compared with only 6% in the first comparison (P<.001). At birth, children with exposure to cocaine remained in the hospital longer (P<.01), but this difference was explained by the increased prevalence of prematurity. By age 2 years, these children had significantly fewer visits for health care maintenance (P<.001), were less likely to have completed immunizations (P<.05), and spent more days in the hospital than comparison children. These differences were not related to prematurity, but were explained by differences in sociodemographic characteristics.
Although prematurity is the major reason for lengthier hospital stays at birth of children with exposure to cocaine, adverse social factors contribute most to inadequate preventive health care and increased stays in the hospital in subsequent years.