Topic: Do differences in where very preterm infants are born contribute to racial and ethnic disparities in morbidity and mortality among blacks, whites, and Hispanics?
Corresponding Author: Elizabeth Howell, MD, Director of the Women’s Health Institute, Icahn School of Medicine at Mount Sinai, New York, and other coauthors.
Bottom Line: Poor performances at New York City hospitals where non-Hispanic black and Hispanic mothers deliver are an important and modifiable cause of racial disparities in neonatal deaths and severe complications.
Results: The risk-standardized morbidity-mortality rate was twice as high for preterm infants born in hospitals in the highest morbidity-mortality tertile versus those born in hospitals with the lowest morbidity-mortality.
Why the Research Is Interesting: Neonatal care has improved substantially over the past decade, yet racial and ethnic disparities in morbidity and mortality continue.
Who: Thirty-nine New York City hospitals were included in the study; participants included 7,177 “very preterm” infants born between 24 and 31 weeks.
When: The study examined data from 2010-2014.
What: The study measured the composite of mortality (neonatal or in-hospital up to a year) or severe morbidity.
How: A population-based retrospective study linked hospital discharge abstract and birth-certificate data sets. A risk-adjusted neonatal morbidity-mortality rate was generated for very preterm infants in each hospital. Hospitals were ranked using this measure, and differences in the distribution of black, Hispanic, and white very preterm births were assessed among the hospitals.
Study Conclusions: Blacks and Hispanic very preterm infants are more likely to be born at hospitals with higher risk-adjusted neonatal morbidity-mortality rates, and these differences contribute to excess morbidity and mortality among black and Hispanic infants. These differences in hospital of birth explained 39.9% of the black-white disparity and 29.5% of the Hispanic-white disparity in outcomes.
Paper Title: Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals
Said Mount Sinai’s Dr. Elizabeth Howell of the research:
It is very important to seriously think about the cause for the severe preterm babies’ morbidities and how it will affect these children later on in life. When a baby is born prematurely, many complications can occur–they can have problems with their lungs, eyes, intestines, and brain, which will affect them later on in life. The real focus here is to try to reduce morbidity in preterm babies and give these kids a chance at a healthier life. This study shines light on the idea that we really need to focus on narrowing disparities when we think about quality improvement. Additionally, these disparities are not just local to New York City. We know that there are infant and neonatal racial and ethnic disparities that have been longstanding in this country.