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Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals.
JAMA Pediatr. 2018 03 01; 172(3):269-277.JP

Abstract

Importance

Substantial quality improvements in neonatal care have occurred over the past decade yet racial and ethnic disparities in morbidity and mortality remain. It is uncertain whether disparate patterns of care by race and ethnicity contribute to disparities in neonatal outcomes.

Objectives

To examine differences in neonatal morbidity and mortality rates among non-Hispanic black (black), Hispanic, and non-Hispanic white (white) very preterm infants and to determine whether these differences are explained by site of delivery.

Design, Setting, and Participants

Population-based retrospective cohort study of 7177 nonanomalous infants born between 24 and 31 completed gestational weeks in 39 New York City hospitals using linked 2010 to 2014 New York City discharge abstract and birth certificate data sets. Mixed-effects logistic regression with a random hospital-specific intercept was used to generate risk-adjusted neonatal morbidity and mortality rates 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 these hospitals. The statistical analysis was performed in 2016-2017.

Exposure

Race/ethnicity.

Main Outcomes and Measures

Composite of mortality (neonatal or in-hospital up to 1 year) or severe neonatal morbidity (bronchopulmonary dysplasia, severe necrotizing enterocolitis, retinopathy of prematurity stage 3 or greater, or intraventricular hemorrhage grade 3 or greater).

Results

Among 7177 very preterm births (VPTBs), morbidity and mortality occurred in 2011 (28%) and was higher among black (893 [32.2%]) and Hispanic (610 [28.1%]) than white (319 [22.5%]) VPTBs (2-tailed P < .001). The risk-standardized morbidity and mortality rate was twice as great for VPTB infants born in hospitals in the highest morbidity and mortality tertile (0.40; 95% CI, 0.38-0.41) as for those born in the lowest morbidity and mortality tertile (0.16; 95% CI, 0.14-0.18). Black (1204 of 2775 [43.4%]) and Hispanic (746 of 2168 [34.4%]) VPTB infants were more likely than white (325 of 1418 [22.9%]) VPTB infants to be born in hospitals in the highest morbidity and mortality tertile (2-tailed P < .001; black-white difference, 20%; 95% CI, 18%-23% and Hispanic-white difference, 11%; 95% CI, 9%-14%). The largest proportion of the explained disparities can be attributed to differences in infant health risks among black, Hispanic, and white VPTB infants. However, 40% (95% CI, 30%-50%) of the black-white disparity and 30% (95% CI, 10%-49%) of the Hispanic-white disparity was explained by birth hospital.

Conclusions and Relevance

Black and Hispanic VPTB infants are more likely to be born at hospitals with higher risk-adjusted neonatal morbidity and mortality rates, and these differences contribute to excess morbidity and mortality among black and Hispanic infants.

Authors+Show Affiliations

Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York.Department of Health Services, University of Washington School of Public Health, Seattle, Washington.Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York.Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York.Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. INSERM Joint Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Biostatistics Sorbonne Paris Cité, University Hospital Department Risks in Pregnancy, Paris Descartes University, Paris, France.

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29297054

Citation

Howell, Elizabeth A., et al. "Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals." JAMA Pediatrics, vol. 172, no. 3, 2018, pp. 269-277.
Howell EA, Janevic T, Hebert PL, et al. Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals. JAMA Pediatr. 2018;172(3):269-277.
Howell, E. A., Janevic, T., Hebert, P. L., Egorova, N. N., Balbierz, A., & Zeitlin, J. (2018). Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals. JAMA Pediatrics, 172(3), 269-277. https://doi.org/10.1001/jamapediatrics.2017.4402
Howell EA, et al. Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals. JAMA Pediatr. 2018 03 1;172(3):269-277. PubMed PMID: 29297054.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals. AU - Howell,Elizabeth A, AU - Janevic,Teresa, AU - Hebert,Paul L, AU - Egorova,Natalia N, AU - Balbierz,Amy, AU - Zeitlin,Jennifer, PY - 2018/1/4/pubmed PY - 2019/9/17/medline PY - 2018/1/4/entrez SP - 269 EP - 277 JF - JAMA pediatrics JO - JAMA Pediatr VL - 172 IS - 3 N2 - Importance: Substantial quality improvements in neonatal care have occurred over the past decade yet racial and ethnic disparities in morbidity and mortality remain. It is uncertain whether disparate patterns of care by race and ethnicity contribute to disparities in neonatal outcomes. Objectives: To examine differences in neonatal morbidity and mortality rates among non-Hispanic black (black), Hispanic, and non-Hispanic white (white) very preterm infants and to determine whether these differences are explained by site of delivery. Design, Setting, and Participants: Population-based retrospective cohort study of 7177 nonanomalous infants born between 24 and 31 completed gestational weeks in 39 New York City hospitals using linked 2010 to 2014 New York City discharge abstract and birth certificate data sets. Mixed-effects logistic regression with a random hospital-specific intercept was used to generate risk-adjusted neonatal morbidity and mortality rates 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 these hospitals. The statistical analysis was performed in 2016-2017. Exposure: Race/ethnicity. Main Outcomes and Measures: Composite of mortality (neonatal or in-hospital up to 1 year) or severe neonatal morbidity (bronchopulmonary dysplasia, severe necrotizing enterocolitis, retinopathy of prematurity stage 3 or greater, or intraventricular hemorrhage grade 3 or greater). Results: Among 7177 very preterm births (VPTBs), morbidity and mortality occurred in 2011 (28%) and was higher among black (893 [32.2%]) and Hispanic (610 [28.1%]) than white (319 [22.5%]) VPTBs (2-tailed P < .001). The risk-standardized morbidity and mortality rate was twice as great for VPTB infants born in hospitals in the highest morbidity and mortality tertile (0.40; 95% CI, 0.38-0.41) as for those born in the lowest morbidity and mortality tertile (0.16; 95% CI, 0.14-0.18). Black (1204 of 2775 [43.4%]) and Hispanic (746 of 2168 [34.4%]) VPTB infants were more likely than white (325 of 1418 [22.9%]) VPTB infants to be born in hospitals in the highest morbidity and mortality tertile (2-tailed P < .001; black-white difference, 20%; 95% CI, 18%-23% and Hispanic-white difference, 11%; 95% CI, 9%-14%). The largest proportion of the explained disparities can be attributed to differences in infant health risks among black, Hispanic, and white VPTB infants. However, 40% (95% CI, 30%-50%) of the black-white disparity and 30% (95% CI, 10%-49%) of the Hispanic-white disparity was explained by birth hospital. Conclusions and Relevance: Black and Hispanic VPTB infants are more likely to be born at hospitals with higher risk-adjusted neonatal morbidity and mortality rates, and these differences contribute to excess morbidity and mortality among black and Hispanic infants. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/29297054/Differences_in_Morbidity_and_Mortality_Rates_in_Black_White_and_Hispanic_Very_Preterm_Infants_Among_New_York_City_Hospitals_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2017.4402 DB - PRIME DP - Unbound Medicine ER -