Increased Care Costs Research Articles

Women at risk for hip fracture following decline in bisphosphonate use.

239 Background: Hip fractures in older adults are associated with increases in morbidity, mortality, and costs of care. Breast cancer treatment, including chemotherapy and endocrine treatment, interfere with bone health, increasing the risk of hip fracture for breast cancer survivors. Multiple studies report large and steady declines in hip fracture incidence coinciding with the availability of bisphosphonates to prevent osteoporosis, although black label warnings about side effects in 2011 steered physicians away from their widespread use. This study estimates trends in hip fracture incidence in a cohort of women with breast cancer before and after 2011. Methods: Retrospective observational study using 2007-2015 SEER-Medicare data for women aged 66 years or older continuously enrolled in fee-for-service Medicare with a first primary diagnosis of breast cancer. Primary outcome was an inpatient admission for a hip fracture within two years of cancer diagnosis. Monthly discrete time survival models were used to estimate the probability of hip fracture after diagnosis conditional on observable factors including demographic characteristics, comorbidities, and the concurrent use of bisphosphonates and cancer treatment. Results: A total of 67,577 patients met the inclusion criteria. The age adjusted incidence of hip fracture declined by 25.1% from 2007 to 2011; from 1093.662 (95% CI, 1027.9-1159.4) to 819.224 (95% CI, 762.1-876.4) per 100,000. However, the incidence of hip fractures stabilized after 2011, with a decline of only 4% from 2011 to 2014, when the incidence was 785.4 (95% CI, 728.6-842.1). The risk of hip fracture increases with age and the number of comorbid conditions. Although more women are prescribed bisphosphonates after a cancer diagnosis, prescription rates declined after 2011. Conclusions: The incidence of hip fractures in breast cancer survivors stabilized after years of steady declines. This significant change in incidence coincided with a large reduction in the use of bisphosphonates after warnings of rare but serious side effects were issued. More research is needed to prevent hip fracture in women with breast cancer and further consideration of available treatments is required for women at high risk for hip fracture.

Impact of mycotoxin contamination in the animal feed industry

Mycotoxin contamination generally affects a large number of raw materials and finished feed intended for animal production. The economic impact on livestock production encompasses both, the cost of eliminating contaminated feed and the reduction in animal productivity. Therefore, the increase in veterinary care costs and technical efforts aimed at reducing mycotoxins negative effects. Cereals and by-products constitute the main ingredients of finished feed in production animals. Food processing affects mycotoxin distribution and concentration. The mycotoxin distribution in cereal processing procedures is a worldwide problem due to the high economic and health impacts. The use of a safe diet in which the risk of mycotoxin contamination can be minimized and the cost/benefit is accurately quantified should allow the maximization of herd productivity. The present review intends to address the problem of animal feed contamination describing the impact on animal health and productivity. Moreover, the economic impact generated by mycotoxins and their control in the animal feed industry was considered.

Increase in direct social care costs of Alzheimer's disease in Japan depending on dementia severity.

With the aging population, costs of direct social support for patients with Alzheimer's disease have grown and will continue to increase. The purpose of the present study was to estimate the cost of direct social support for Alzheimer's disease under long-term care insurance in Japan. This cross-sectional study included 169 patients with Alzheimer's disease or mild cognitive impairment who visited a memory clinic and were followed over time. Dementia severity, use of care services and costs were analyzed. The use of direct social support and costs increased significantly between patients with mild, moderate and severe dementia (P < 0.001). In particular, the use of day services and short stay services increased with the severity of dementia (P < 0.001). Similar findings were obtained when participants were stratified by long-term care insurance care levels. Of 169 participants, 49 had not applied for long-term care insurance, although their dementia severity was not different from support-need level 1 and care-need level 1. Logistic regression analysis of "did not apply" and "applied and certified" groups showed significant differences not only in dementia severity, but also in age (odds ratio 1.112, 95% confidence interval 1.037-1.193, P = 0.003) and living arrangements (odds ratio 0.257, 95% confidence interval 0.076-0.862, P = 0.028). As the number of patients with Alzheimer's disease increases, direct social costs will increase. The findings of this study might help standardize the type of direct social support provided after diagnosis of Alzheimer's disease and contribute to the development of cost-effective care for these patients. Geriatr Gerontol Int 2019; 19: 1023-1029.

The Frequency of Intrapartum Caesarean Section Use With the WHO Partograph Versus Zhang’s Guideline in the Labour Progression Study (LaPS): A Multicentre, Cluster-Randomised Controlled Trial

(Abstracted from Lancet 2019;393:340–348) The rate of cesarean sections is increasing worldwide and is a great concern because of its association with adverse outcomes for mothers and babies, the more than 50% risk for a subsequent cesarean section, and the increase in costs of labor care. Assessment and identification of labor progression and prolonged labor, denoted as true labor dystocia and often caused by inadequate contractions or obstructed labor, have profound effects on labor management and intrapartum cesarean section (ICS) use, because labor dystocia is the main indication for an ICS.

Impact Of Physicians, Nurse Practitioners, And Physician Assistants On Utilization And Costs For Complex Patients.

Because of workforce needs and demographic and chronic disease trends, nurse practitioners (NPs) and physician assistants (PAs) are taking a larger role in the primary care of medically complex patients with chronic conditions. Research shows good quality outcomes, but concerns persist that NPs' and PAs' care of vulnerable populations could increase care costs compared to the traditional physician-dominated system. We used 2012-13 Veterans Affairs data on a cohort of medically complex patients with diabetes to compare health services use and costs depending on whether the primary care provider was a physician, NP, or PA. Case-mix-adjusted total care costs were 6-7percent lower for NP and PA patients than for physician patients, driven by more use of emergency and inpatient services by the latter. We found that use of NPs and PAs as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs.

A comparison of adherence, outcomes, and costs among opioid use disorder Medicaid patients treated with buprenorphine and methadone: A view from the payer perspective

Medication-assisted treatment (MAT) with methadone or buprenorphine has been shown to be more effective at reducing the use of illicit opioids, the risk of drug-related overdose, and overall healthcare costs, on average, compared to abstinence-based addiction treatments for individuals with an opioid use disorder (OUD). Individuals who are adherent to MAT are more likely to experience positive outcomes.We used physical and behavioral Medicaid claims data of individuals newly treated with methadone (n = 212) and buprenorphine (n = 972) to examine the overall predictors of adherence, differences in adherence to each medication, the relationship between adherence and ED nonfatal drug-related overdose, and differences in total cost of care between the two medications.We found that older individuals and women had significantly lower risk of non-adherence. At six months, only 3.6% of individuals who were adherent to either treatment experienced a nonfatal drug-related overdose in the ED, compared to 13.2% of individuals who were non-adherent. We found no significant difference between methadone and buprenorphine on nonfatal drug-related overdose. Non-adherence to methadone was associated with a significant increase in total cost of care. Implications for how these results could be used to improve the overall impact of MAT are discussed.

The burden of hyponatremia and hypercalcemia on hospitalizations and mortality in lung cancer patients in the United States: An analysis of nationwide inpatient database.

e18256 Background: In 2018, there were over 234,030 patients diagnosed with lung cancer in the US with over 154,050 deaths. While the incidence continues to fall (mostly due to reduced tobacco consumption ), the mortality continues to be high with an overall median five year survival rate of only 19%. It is important to identify factors which are associated with worse outcomes in these patients. We aim to note the trends in patients hospitalized with lung cancer who have hyponatremia and hypercalcemia. Methods: We used the Nationwide Inpatient Sample (2002-2013) to identify lung cancer hospitalizations with hyponatremia and hypercalcemia. We analyzed trends in incidence, in-hospital mortality, length of stay (LOS) and cost. We calculated adjusted odds ratios (aOR) for outcomes including in-hospital mortality. Results: A total of 1,404,228 patients were studied with lung cancer were hospitalized from 2005-2014. A number of admissions has been progressively declining from 159,568 in 2005 to 123,305 in 2014 with a relative decline of 21.8%. The overall incidence of hyponatremia in these patients was 8.62%, and it has been trending up from 6.79% to 10.48% (p &lt; 0.001) from 2005-2014 with a relative increase of 57%. Hypercalcemia was reported in 2.59 % of patients admitted with lung cancer. The number of hospitalizations in lung cancer patients with hypercalcemia has increased from 2.19% to 3.17% (p &lt; 0.001) with a relative increase of 49.3%. Hospitalizations for hyponatremia and hypercalcemia were more frequent in age 50-64 years, males and smokers. Lung cancer patients with hyponatremia have in-hospital mortality of 12.9 % (OR 1.43, p &lt; 0.001). Patients who have hypercalcemia have in hospital mortality of 17.1%( OR 1.15, p &lt; 0.001). Conclusions: This study studies trends in hospitalizations in patient with lung cancer and incidence of hyponatremia and hypercalcemia. It is noted that hyponatremia and hypercalcemia are associated with increase the risk of in hospital mortality and increase cost of care in lung cancer patients. Utilization of these findings in guiding management may lead to decreased hospitalizations, hospital stays, and improve outcomes for these patients.

Costs of people with diabetes in relation to average glucose control: an empirical approach controlling for year of onset cohorts.

To estimate the impact of glycaemic control and time since diabetes diagnosis on care costs incurred by people with type 2 diabetes mellitus (T2DM). Random-effects linear regression models were run to test the impact of average glucose control (HbA1c) and time since diabetes diagnosis on total care spending in people with T2DM, adjusting for year of onset and other covariates. Two datasets were linked, Vektis (healthcare costs reimbursed by the Dutch mandatory health insurance) and Zodiac (clinical and sociodemographic data). The sample includes 22,612 observations, grouped in 5653 individuals from the Northern part of the Netherlands, covering 4years (2008-2011). A 1% point increase in HbA1c is associated with a 2.2% higher total care costs. However, when treatment modality is included, the results are modified. A 1% point increase (11mol/mol) in HbA1c is significantly associated with 3.4% higher total care costs for individuals without glucose-lowering treatment. Being treated with insulin is significantly associated with an increase in costs of 30-38% for every additional percentage point of HbA1c, depending on the covariates included. Without controlling for year of onset, an additional year of diabetes duration relates to 2.6% higher care costs, while this is 4.9% controlling for year of onset. The effect of HbA1c and diabetes duration differs between types of costs. HbA1c, insulin treatment and diabetes duration are the main drivers of increasing care costs. The results signal the relevance of controlling for HbA1c together with treatment modality, diabetes duration and year of diagnosis effects.

Costs of Long-Term Post-Transplantation Care in Kidney Transplant Recipients

BackgroundSolid organ transplantations lead to improvements in patient survival and patient quality of life, as well as health care system economic benefits. However, over time, health problems can accumulate post-transplantation. Therefore, we hypothesized that in the late post-transplantation period, the costs of patient care increase.Material/MethodsWe retrospectively calculated costs of patient care in 306 randomly selected kidney transplant recipients who had different follow-up time periods after kidney transplantation (between 1 year and 25 years). Direct costs of inpatient care as well as outpatient care, from the perspective of a transplant center, were considered.ResultsThe mean costs, as well as median costs of post-transplantation care were the highest in the first post-transplantation year. Afterwards, the mean costs and median costs decreased, without an increase in costs of care in the late post-transplantation periods.ConclusionsFrom the perspective of a transplant center, costs of long-term post-kidney transplantation care did not increase in the late period, even as long as 25 years after transplantation. Our results confirmed that kidney transplantation is a modality of renal replacement therapy that can be associated with economic benefits even when considering long-term post-transplantation care.

Obesity and overweight—their impact on individual and corporate health

Obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese. Once associated with high-income countries, obesity is now also prevalent in low- and middle-income countries. Not only an individual suffers from ill health, but also family members and organizations bear its consequences. The purpose of this study is to identify the prevalence of obesity and overweight and its association with five risk factors, namely unhealthy diet, physical inactivity, stress, alcohol consumption and smoking, in corporate organizations. High expenses born by corporations because of high BMIs, which lead to overweight and obesity, are a problem. Descriptive research based on a cross-sectional study is used to target office workers in three different groups: group A is people aged 20–30 years old, group B is people 30–40 years old, and group C is people aged > 40 years. This study was conducted in West Asia, using a questionnaire as the instrument for the survey. The data were analyzed using regression and the Simple Lifestyle Index (SLSI). The higher the index, the healthier the person's lifestyle is. The professional’s working hours in the office were observed. The results indicated that the more working hours in a day, the greater the chances of becoming obese or overweight. It is found that of the five risk factors, only two, unhealthy diet and physical inactivity, were found to have significant relationships (p < 5%) with overweight and obesity. The other three factors, stress, alcohol consumption and smoking, did not play a significant role in increasing an individual's weight. As a person’s BMI increases, the number of sick days, medical claims and health care costs increase. To reduce the burden of high medical costs on individuals and businesses, it is essential to have a health care awareness program.

Changes in Australian practice patterns for glaucoma management

The demand for glaucoma care is projected to increase significantly with the ageing population. To characterize trends in Australian practice patterns for glaucoma management over the 15-y period between 2003 and 2017. Retrospective audit. The Medicare eligible population. Audit of Medicare Benefits Schedule item number reimbursements in the private healthcare sector, and dispensed Pharmaceutical Benefits Scheme (PBS) prescriptions. Number, unadjusted cost and services per capita in the enrolled population. The number of medication prescriptions peaked in 2015, but then declined by 14.9%. PBS expenditure on glaucoma medications has been falling since 2012. There was a 9.2-fold increase in fixed-combination prescriptions and 281-fold increase in unpreserved medication prescriptions. In 2017, optometrists generated 1.86% of glaucoma prescriptions. Reimbursements for computerized perimetry increased dramatically for optometrists, and in 2017 optometrist-initiated perimetry exceeded ophthalmologist-initiated perimetry by 35.3%. There were significant increases in laser procedure rates, including laser trabeculoplasty (4.61-fold), laser iridotomy (2.55-fold) and cyclodestructive procedures (2.33-fold). There was a 3.83-fold increase in glaucoma drainage device insertions. Ab interno trabecular microbypass procedures increased 715% from 2014 to 2017. Adjusted for Medicare population, trabecular microbypass is performed at more than twice the rate of primary filtering operations. This is the first time that glaucoma medication use and expenditure have declined since auditing began in 1992. Glaucoma laser procedures, drainage device implantation and trabecular microbypass increased substantially over the study period. In contrast, the rate of primary filtering operations increased in proportion to population growth. The increase in overall cost of glaucoma care has primarily been driven by computerized perimetry; however, this has been partially offset by a decline in medication expenditure.

Is the Wireless Monitoring a Technological Innovation Suitable in Internal Medicine Units?

In recent years, the Internal Medicine (IM) Ward has been receiving an increasingly heterogeneous group of patients, many affected by acute or chronic diseases of varying severity, who are often elderly, frail, with co-morbidities, requiring intensive care due to epidemiological transition. Hospitalization of medical patients in large wards without prior stratification of severity, complexity, level of dependence, co-morbidities and without a proper assessment of the risk of rapid clinical deterioration, can lead to suboptimal treatment, resulting in prolonged hospital stay and increased care costs. Continuous monitoring of Emergency Room activity data has shown an increasing trend, regardless of the season, in ER presentation and subsequent hospitalization of patients over 65 years with exacerbation of chronic diseases such as a 1% increase in ER presentations could result in a 10% increase in Internal Medicine admissions, causing overcrowding both ER and IM ward [1].

Current Status of Novel Biomarkers for the Diagnosis of Acute Kidney Injury: A Historical Perspective.

Acute kidney injury (AKI) is a common and serious medical condition associated with significant increases in morbidity, mortality, and cost of care. Because of the high incidence and poor outcomes associated with AKI, there has been significant interest in the development of new therapies for the prevention and treatment of the disease. A lack of efficacy in drug trials led to the concern that AKI was not being diagnosed early enough for an effective intervention and that a rise in serum creatinine itself is not a sensitive-enough marker. Researchers have been searching for novel biomarkers that can not only assess a decline in kidney function but also demonstrate structural damage to the kidney and at time points earlier than increases in serum creatinine measurements allow. Over the past 10 years, there have been 3300 new publications and hundreds of new biomarkers investigated, yet concern still remains regarding AKI biomarker performance. The AKI biomarkers are yet to be widely utilized in clinical practice, leading some to question whether AKI biomarkers will ever reach their initial promise. However, we believe that biomarkers are an important part of current and future AKI research and clinical management. In this review, we compare the historical contexts of acute myocardial ischemia and AKI biomarker development to illustrate the progress that has been made within AKI biomarker research in a relatively short period of time and also to point out key differences between the disease processes that have been barriers to widespread AKI biomarker adoption. Finally, we discuss potential paths by which biomarkers can lead to appropriate AKI treatment responses that lower morbidity and mortality.

Hospital uncompensated care and patient experience: An instrumental variable approach.

Examine the endogenous relationship between uncompensated care and hospital patient experience scores. The Hospital Consumer Assessment of Healthcare Providers and Systems Survey, CMS Healthcare Cost Report Information System, and the US Census Bureau. The exogenous change in uncompensated care caused by the 2014 Medicaid expansion was exploited to measure the effect of uncompensated care on patient experience scores using a 2SLS regression with instrumental variables approach. U.S. general, short-term hospitals whose DSH status remained constant and had nonmissing data for 2011-2015, which totaled 969 unique hospitals per year. The effect of uncompensated care on patient experience was in the predicted direction, with three of the 10 measures being statistically significant. A one percentage point increase in uncompensated care costs resulted in a 0.25-0.50 percentage point decrease in select patient experience scores. Results indicate a weak relationship between uncompensated care and patient experience scores, as a reduction in uncompensated care is related to quality improvement for some hospitals. These findings have implications for hospitals as they navigate changing reimbursement structures and policy makers considering changes to Obama-era health care reforms.

Impact of mechanical ventilation on the daily costs of ICU care: a systematic review and meta regression.

The impact of mechanical ventilation on the daily costs of intensive care unit (ICU) care is largely unknown. We thus conducted a systematic search for studies measuring the daily costs of ICU stays for general populations of adults (age ≥18 years) and the added costs of mechanical ventilation. The relative increase in the daily costs was estimated using random effects meta regression. The results of the analyses were applied to a recent study calculating the excess length-of-stay associated with ICU-acquired (ventilator-associated) pneumonia, a major complication of mechanical ventilation. The search identified five eligible studies including a total of 54 766 patients and ~238 037 patient days in the ICU. Overall, mechanical ventilation was associated with a 25.8% (95% CI 4.7%-51.2%) increase in the daily costs of ICU care. A combination of these estimates with standardised unit costs results in approximate daily costs of a single ventilated ICU day of €1654 and €1580 in France and Germany, respectively. Mechanical ventilation is a major driver of ICU costs and should be taken into account when measuring the financial burden of adverse events in ICU settings.

The Long-Term Care Insurance System in Japan: Past, Present, and Future.

The Japanese population is rapidly aging. The proportion of people aged ≥65 was 27.3% in 2016, the highest in the world. Japan achieved universal health coverage for medical care in 1961 with the introduction of the National Health Insurance (NHI) system. However, increasing expenditure on inpatient care for old people became a significant issue in society. At that time, tax-supported in-home services were mainly for old people with low incomes and little care given by family. To tackle these problems, universal health coverage for long-term care was introduced in 2000 under the Long-Term Care Insurance (LTCI) system. People aged ≥65 who satisfied the eligibility criteria and those aged 40–64 with age-related diseases are entitled to receive long-term care services at home or in facilities, irrespective of income level and availability of family caregiving. The practical benefits in kind under the LTCI system for family caregivers have been demonstrated. However, because of a recent increase in long-term care costs, especially facility-based costs, it may be necessary to give more support to family (informal) caregivers who participate in home-based long-term care. Health services research using nationwide claims data would help sustain the LTCI system through evidence-based policymaking. Recent studies have explored how to prevent deterioration of care need levels among residents of long-term care welfare facilities and how to promote a shift from facility-based to home-based long-term care services. By 2025, as the baby boomer generation is projected to reach the age of 75, the Japanese government is planning to establish a community-based integrated care system. Harmonization between long-term care and medical care, involving the informal sector and nonprofit organizations, would mitigate the increasing cost of both the NHI and LTCI systems. To achieve this, more research is warranted to understand how long-term care, medical care, and informal care can be effectively integrated in the community.

Real time visualization of asymmetrical sitting posture

Asymmetrical sitting posture (ASP) affects the body mechanics and puts various body segments under strain which may lead to health problems including musculoskeletal pain, low back pain and spinal deformity resulting increased care costs. The tools and methodologies used to assess human posture are often arbitrary and studied by physicians, physiotherapists and researchers in clinical settings. For example, clinical scales such as the Posture Index or Postural Assessment Scale are subjective or semi-subjective, based on visual observation and require clinical expertise to identify asymmetry. More objective gold standard methods such as Motion Capture Systems rely on access to expensive complex equipment based in laboratories. These are not widely available for several reasons including, scarcity of equipment, need for technical staff, time consuming procedures and overall expense. Therefore, there is a need for a low cost, portable automatic posture monitoring system which would help address this challenge. We develop an automatic ASP monitoring system to provide real time visualization and information about sitting posture. We build flexible pressure sensor (FPS) at six different locations on a chair to collect pressure information using piezoresistive conductive film. The collected data from FPSs are then transferred to a smartphone application using Bluetooth. We develop a dedicated Android App to collect FPSs reading and provide real time visualizations of information. The results show that FPS can be used for objective monitoring of sitting posture. It can also be utilized to provide useful information about patients with pelvic asymmetry in rehabilitation medicine. Our system would significantly simplify the sitting posture monitoring protocols and open possibilities for office, school and home based assessment and support for posture improvement. Furthermore, results from this study will be used to develop a new quantitative posture measurement tool for clinical use.

Cost Implications of Anticoagulation Strategies After Percutaneous Coronary Intervention Among Patients With Atrial Fibrillation (A PIONEER-AF PCI Analysis)

The PIONEER AF-PCI trial demonstrated that in atrial fibrillation patients who underwent intracoronary stenting, either rivaroxaban 15 mg daily plus P2Y12 inhibitor monotherapy (Group 1) or 2.5 mg rivaroxaban twice daily plus dual antiplatelet therapy (DAPT) (Group 2) was associated with fewer recurrent hospitalizations, primarily for bleeding and cardiovascular events, compared with standard-of-care vitamin K antagonist and DAPT (Group 3). Associated costs are unknown. This study estimates costs associated with rivaroxaban strategies compared with vitamin K antagonist and DAPT. Medication costs were estimated using wholesale acquisition costs, medication discontinuation rates, and costs of monitoring. Using a large US healthcare claims database, the mean adjusted increase in 1-year cost of care for individuals with atrial fibrillation and percutaneous coronary intervention (PCI) rehospitalized for bleeding, cardiovascular, and other events was compared with those not rehospitalized. Using adjudicated rehospitalization rates from PIONEER AF-PCI, cost differences were estimated. Rates of rehospitalization for bleeding were 6.5%, 5.4%, 10.5%, and 20.3%, 20.3%, 28.4% for cardiovascular events in Groups 1, 2, and 3. Medication and monitoring costs were $3,942, $4,115, and $1,703. One-year costs for all recurrent hospitalization costs and/or patient for the groups were $24,535, $20,205, and $29,756. One-year cost increase associated with bleeding rehospitalizations and/or patient was $4,160, $3,212, and $6,876 and was $13,264, $11,545, and $17,220 for cardiovascular rehospitalizations and/or patient. Overall estimated cost per patient was $28,476, $24,320, and $31,458. Compared with warfarin, both rivaroxaban treatment strategies had higher medication costs, but these were more than accounted for by fewer hospitalizations.

Taking Another Look: Thoughts on Behavioral Symptoms in Dementia and Their Measurement.

This article proposes taking another look at behavioral symptoms of dementia (BSDs) both from a theoretical perspective that informs research and practice and from a measurement perspective. We discuss why this rethinking of behaviors impacts current models of care and our ability to better detect outcomes from interventions. We propose that BSDs be viewed from a pattern perspective and provide some suggestions for how to identify and measure these patterns that can influence the timing and type of intervention. Evidence suggests that BSDs are complex, sequential, patterned clusters of behavior recurring repeatedly in the same individual and escalate significantly without timely intervention. However, BSDs are frequently viewed as separate behaviors rather than patterns or clusters of behaviors, a view that affects current research questions as well as the choice, timing, and outcomes of interventions. These symptoms cause immense distress to persons with the disease and their caregivers, trigger hospitalizations and nursing home placement, and are associated with increased care costs. Despite their universality and that symptoms manifest across disease etiologies and stages, behaviors tend to be underrecognized, undertreated, and overmanaged by pharmacological treatments that may pose more harm than benefit.

Neonatal risk factors in cerebral palsy

Cerebral palsy (CP) is a movement disorder caused by damage to the developing brain. It affects patient self-help, creates family problems, and increases care costs. CP has many risk factors, although the trigger is often unclear, resulting in treatment delays and permanent complications. To improve monitoring and early diagnosis, a study to establish total risk factors for predicting cerebral palsy in the neonate is a useful study especially for patients in small hospitals who do not have specialized doctors. A case-control study of CP risk factors in neonate, born at Thammasat University Hospital, Thailand from 2005 to 2014. Using multivariable logistic regression, neonatal and maternal characteristics, as well as prenatal, perinatal and postnatal risks, were compared in normal children (control) and patients diagnosed with CP (case). These risks and evidence of difference ( P -value) are in Table 1 and Table 2 ; CP independent risk is in Table 3 . Cerebral and non-cerebral malformation, small for gestational age, preterm, multifetal gestation, neonatal jaundice, and non-congenital infections of neonatal infants were risks, with odds ratio (OR) = 313.03, 16.45, 5.67, 8.45,11.39, 10.99 and 147.87, respectively. Cerebral and non-cerebral malformation, small for gestational age, preterm, multifetal gestation, neonatal jaundice, and non-congenital infections of the neonatal infants were predictive risks. However, low Apgar score, uterine and cord anomalies, neonatal seizure, neonatal encephalopathy, congenital infections, and ventilator use remain questionable with low incidence. Multicenter research to enhance data scope would be useful.