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Racial/Ethnic Disparities in Morbidity and Mortality for Preterm Neonates Admitted to a Tertiary Neonatal Intensive Care Unit.
J Racial Ethn Health Disparities. 2018 08; 5(4):867-874.JR

Abstract

OBJECTIVE

The objective of this study was to assess whether in-hospital morbidity or mortality differed by race/ethnicity for preterm neonates admitted to the neonatal intensive care unit (NICU).

STUDY DESIGN

In a retrospective cohort study, preterm infants, < 37 weeks, were admitted to the NICU from 1994 to 2009. Exclusions included structural anomalies and aneuploidy. Primary outcome was in-hospital mortality (IHM). Secondary outcomes were respiratory distress syndrome (RDS), interventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP). Sub-analysis of very preterm (VPT) infants, < 28 weeks, was performed. Five racial/ethnic groups (REGs) were compared: White, Black, Hispanic, Asian, and Mixed. Associations were modeled by logistic regression. White neonates (WNs) were the referent group. Unadjusted and adjusted odds ratios and 95% confidence intervals for remaining REGs were reported. p value was significant at 5% for overall tests and at Bonferroni-corrected level < 0.0125 for between-race comparisons with WNs.

RESULTS

Four thousand nine hundred fifty-five preterm neonates were identified; 153 were excluded leaving 4802 for analysis. After controlling covariates that were chosen a priori, there was no difference across REGs for IHM (all between-race comparison p values > 0.0125). There was a significant difference in RDS among Black neonates (BNs) (aOR 0.57, 95% CI 0.45-0.73; p < 0.001) and Hispanic neonates (HNs) (aOR 0.67, 95% CI 0.50-0.89; p = 0.005) compared to WNs. The risk of ROP was significantly different across REGs with HNs having a 70% increase in ROP (aOR 1.70, 95% CI 1.15-2.49; p = 0.008) and Mixed neonates (MNs) experiencing a 55% reduction (aOR 0.45, 95% CI 0.29-0.68; p < 0.001) compared to WNs. There was no difference in IVH or NEC across REGs (all p values > 0.0125). In the VPT cohort sub-analysis, BNs experienced a significant 59% reduction in IHM compared to WNs (BNs aOR 0.41, 95% CI 0.22-0.73; p = 0.003). MNs experienced a 46% reduction in ROP compared to WNs (aOR 0.54, 95% CI 0.35-0.81; p = 0.004). There was no difference in RDS, IVH, or NEC in very preterm infants across REGs (all between comparison p values > 0.0125).

CONCLUSION

In preterm neonates, in-hospital mortality does not significantly differ across racial and ethnic groups. However, in very preterm infants, in-hospital mortality for Black neonates is improved. There are morbidity differences (RDS, ROP) seen among racial/ethnic groups.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of Connecticut Health, Farmington, CT, USA. townsel@uchc.edu. Division of Maternal Fetal Medicine, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06030-2947, USA. townsel@uchc.edu.Department of Obstetrics and Gynecology, University of Connecticut Health, Farmington, CT, USA.Department of Community Medicine, Connecticut Institute for Clinical and Translational Science, University of Connecticut Health, Farmington, CT, USA.Department of Obstetrics and Gynecology, University of Connecticut Health, Farmington, CT, USA.Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, Farmington, CT, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29071590

Citation

Townsel, Courtney, et al. "Racial/Ethnic Disparities in Morbidity and Mortality for Preterm Neonates Admitted to a Tertiary Neonatal Intensive Care Unit." Journal of Racial and Ethnic Health Disparities, vol. 5, no. 4, 2018, pp. 867-874.
Townsel C, Keller R, Kuo CL, et al. Racial/Ethnic Disparities in Morbidity and Mortality for Preterm Neonates Admitted to a Tertiary Neonatal Intensive Care Unit. J Racial Ethn Health Disparities. 2018;5(4):867-874.
Townsel, C., Keller, R., Kuo, C. L., Campbell, W. A., & Hussain, N. (2018). Racial/Ethnic Disparities in Morbidity and Mortality for Preterm Neonates Admitted to a Tertiary Neonatal Intensive Care Unit. Journal of Racial and Ethnic Health Disparities, 5(4), 867-874. https://doi.org/10.1007/s40615-017-0433-2
Townsel C, et al. Racial/Ethnic Disparities in Morbidity and Mortality for Preterm Neonates Admitted to a Tertiary Neonatal Intensive Care Unit. J Racial Ethn Health Disparities. 2018;5(4):867-874. PubMed PMID: 29071590.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial/Ethnic Disparities in Morbidity and Mortality for Preterm Neonates Admitted to a Tertiary Neonatal Intensive Care Unit. AU - Townsel,Courtney, AU - Keller,Rebecca, AU - Kuo,Chia-Ling, AU - Campbell,Winston A, AU - Hussain,Naveed, Y1 - 2017/10/25/ PY - 2017/06/20/received PY - 2017/09/21/accepted PY - 2017/09/18/revised PY - 2017/10/27/pubmed PY - 2019/11/19/medline PY - 2017/10/27/entrez KW - Health disparities KW - Mortality KW - Preterm infants KW - Racial disparities KW - Very preterm infants SP - 867 EP - 874 JF - Journal of racial and ethnic health disparities JO - J Racial Ethn Health Disparities VL - 5 IS - 4 N2 - OBJECTIVE: The objective of this study was to assess whether in-hospital morbidity or mortality differed by race/ethnicity for preterm neonates admitted to the neonatal intensive care unit (NICU). STUDY DESIGN: In a retrospective cohort study, preterm infants, < 37 weeks, were admitted to the NICU from 1994 to 2009. Exclusions included structural anomalies and aneuploidy. Primary outcome was in-hospital mortality (IHM). Secondary outcomes were respiratory distress syndrome (RDS), interventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP). Sub-analysis of very preterm (VPT) infants, < 28 weeks, was performed. Five racial/ethnic groups (REGs) were compared: White, Black, Hispanic, Asian, and Mixed. Associations were modeled by logistic regression. White neonates (WNs) were the referent group. Unadjusted and adjusted odds ratios and 95% confidence intervals for remaining REGs were reported. p value was significant at 5% for overall tests and at Bonferroni-corrected level < 0.0125 for between-race comparisons with WNs. RESULTS: Four thousand nine hundred fifty-five preterm neonates were identified; 153 were excluded leaving 4802 for analysis. After controlling covariates that were chosen a priori, there was no difference across REGs for IHM (all between-race comparison p values > 0.0125). There was a significant difference in RDS among Black neonates (BNs) (aOR 0.57, 95% CI 0.45-0.73; p < 0.001) and Hispanic neonates (HNs) (aOR 0.67, 95% CI 0.50-0.89; p = 0.005) compared to WNs. The risk of ROP was significantly different across REGs with HNs having a 70% increase in ROP (aOR 1.70, 95% CI 1.15-2.49; p = 0.008) and Mixed neonates (MNs) experiencing a 55% reduction (aOR 0.45, 95% CI 0.29-0.68; p < 0.001) compared to WNs. There was no difference in IVH or NEC across REGs (all p values > 0.0125). In the VPT cohort sub-analysis, BNs experienced a significant 59% reduction in IHM compared to WNs (BNs aOR 0.41, 95% CI 0.22-0.73; p = 0.003). MNs experienced a 46% reduction in ROP compared to WNs (aOR 0.54, 95% CI 0.35-0.81; p = 0.004). There was no difference in RDS, IVH, or NEC in very preterm infants across REGs (all between comparison p values > 0.0125). CONCLUSION: In preterm neonates, in-hospital mortality does not significantly differ across racial and ethnic groups. However, in very preterm infants, in-hospital mortality for Black neonates is improved. There are morbidity differences (RDS, ROP) seen among racial/ethnic groups. SN - 2196-8837 UR - https://www.unboundmedicine.com/medline/citation/29071590/Racial/Ethnic_Disparities_in_Morbidity_and_Mortality_for_Preterm_Neonates_Admitted_to_a_Tertiary_Neonatal_Intensive_Care_Unit_ L2 - https://medlineplus.gov/prematurebabies.html DB - PRIME DP - Unbound Medicine ER -