Ten-year trends (FY2014–2023) in ritodrine hydrochloride injection use for threatened preterm labor across all 47 Japanese prefectures, using nationwide medical claims and statistical survey data, with a cross-sectional analysis of factors associated with usage.
Ritodrine injection use fell by more than 45% per 1000 deliveries over 10 years, with FY2017 as the inflection point after which decline accelerated; prefectural usage still varied up to 13.58-fold, with spatial clustering of high-use regions driven by Perinatal Medical Center density, hospital admission rates for preterm labor/birth, and proportion of hospitals among delivery facilities.
Ecological design prevents inference about individual patient outcomes or clinical appropriateness; aggregated claims data may not capture clinical context (e.g., severity of threatened preterm labor); findings are specific to Japan's healthcare system and may not generalize elsewhere.
Despite a national shift in guidelines away from ritodrine, wide regional variation persists in Japan—clinicians and policymakers should be aware that local healthcare infrastructure (e.g., Perinatal Medical Center density) is driving practice differences, and efforts to standardize tocolytic use in high-use regions are warranted.
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