Tags

Type your tag names separated by a space and hit enter

Association of Race/Ethnicity With Very Preterm Neonatal Morbidities.
JAMA Pediatr. 2018 11 01; 172(11):1061-1069.JP

Abstract

Importance

Severe morbidity in very preterm infants is associated with profound clinical implications on development and life-course health. However, studies of racial/ethnic disparities in severe neonatal morbidities are scant and suggest that these disparities are modest or null, which may be an underestimation resulting from the analytic approach used.

Objective

To estimate racial/ethnic differences in severe morbidities among very preterm infants.

Design, Setting, and Participants

This population-based retrospective cohort study was conducted in New York City, New York, using linked birth certificate, mortality data, and hospital discharge data from January 1, 2010, through December 31, 2014. Infants born before 24 weeks' gestation, with congenital anomalies, and with missing data were excluded. Racial/ethnic disparities in very preterm birth morbidities were estimated through 2 approaches, conventional analysis and fetuses-at-risk analysis. The conventional analysis used log-binomial regression to estimate the relative risk of 4 severe neonatal morbidities for the racial/ethnic groups. For the fetuses-at-risk analysis, Cox proportional hazards regression with death as competing risk was used to estimate subhazard ratios associating race/ethnicity with each outcome. Estimates were adjusted for sociodemographic factors and maternal morbidities. Data were analyzed from September 5, 2017, to May 21, 2018.

Main Outcomes and Measures

Four morbidity outcomes were defined using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes: necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia, and retinopathy of prematurity.

Results

In total, 582 297 infants were included in this study. Of these infants, 285 006 were female (48.9%) and 297 291 were male (51.0%). Using the conventional approach in the very preterm birth subcohort, black compared with white infants had an increased risk of only bronchopulmonary dysplasia (adjusted risk ratio [aRR], 1.34; 95% CI, 1.09-1.64) and a borderline increased risk of necrotizing enterocolitis (aRR, 1.39; 95% CI, 1.00-1.93). Hispanic infants had a borderline increased risk of necrotizing enterocolitis (aRR, 1.39; 95% CI, 0.98-1.96), and Asian infants had an increased risk of retinopathy of prematurity (aRR, 1.85; 95% CI, 1.15-2.97). In the fetuses-at-risk analysis, black infants had a 4.40 times higher rate of necrotizing enterocolitis (95% CI, 2.98-6.51), a 2.73 times higher rate of intraventricular hemorrhage (95% CI, 1.63-4.57), a 4.43 times higher rate of bronchopulmonary dysplasia (95% CI, 2.88-6.81), and a 2.98 times higher rate of retinopathy of prematurity (95% CI, 2.01-4.40). Hispanic infants had an approximately 2 times higher rate for all outcomes, and Asian infants had increased risk only for retinopathy of prematurity (adjusted hazard ratio, 2.43; 95% CI, 1.43-4.11).

Conclusions and Relevance

In this study, racial/ethnic disparities in neonatal morbidities among very preterm infants appear to be sizable, but may have been underestimated in previous studies, and may have implications for the future. Understanding these racial/ethnic disparities is important, as they may contribute to inequalities in health and development later in the child's life.

Authors+Show Affiliations

Blavatnik Family 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.Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Biostatistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.University of Washington School of Public Health, Seattle.Blavatnik Family 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.Blavatnik Family 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.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30208467

Citation

Janevic, Teresa, et al. "Association of Race/Ethnicity With Very Preterm Neonatal Morbidities." JAMA Pediatrics, vol. 172, no. 11, 2018, pp. 1061-1069.
Janevic T, Zeitlin J, Auger N, et al. Association of Race/Ethnicity With Very Preterm Neonatal Morbidities. JAMA Pediatr. 2018;172(11):1061-1069.
Janevic, T., Zeitlin, J., Auger, N., Egorova, N. N., Hebert, P., Balbierz, A., & Howell, E. A. (2018). Association of Race/Ethnicity With Very Preterm Neonatal Morbidities. JAMA Pediatrics, 172(11), 1061-1069. https://doi.org/10.1001/jamapediatrics.2018.2029
Janevic T, et al. Association of Race/Ethnicity With Very Preterm Neonatal Morbidities. JAMA Pediatr. 2018 11 1;172(11):1061-1069. PubMed PMID: 30208467.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Race/Ethnicity With Very Preterm Neonatal Morbidities. AU - Janevic,Teresa, AU - Zeitlin,Jennifer, AU - Auger,Nathalie, AU - Egorova,Natalia N, AU - Hebert,Paul, AU - Balbierz,Amy, AU - Howell,Elizabeth A, PY - 2018/9/13/pubmed PY - 2019/10/8/medline PY - 2018/9/13/entrez SP - 1061 EP - 1069 JF - JAMA pediatrics JO - JAMA Pediatr VL - 172 IS - 11 N2 - Importance: Severe morbidity in very preterm infants is associated with profound clinical implications on development and life-course health. However, studies of racial/ethnic disparities in severe neonatal morbidities are scant and suggest that these disparities are modest or null, which may be an underestimation resulting from the analytic approach used. Objective: To estimate racial/ethnic differences in severe morbidities among very preterm infants. Design, Setting, and Participants: This population-based retrospective cohort study was conducted in New York City, New York, using linked birth certificate, mortality data, and hospital discharge data from January 1, 2010, through December 31, 2014. Infants born before 24 weeks' gestation, with congenital anomalies, and with missing data were excluded. Racial/ethnic disparities in very preterm birth morbidities were estimated through 2 approaches, conventional analysis and fetuses-at-risk analysis. The conventional analysis used log-binomial regression to estimate the relative risk of 4 severe neonatal morbidities for the racial/ethnic groups. For the fetuses-at-risk analysis, Cox proportional hazards regression with death as competing risk was used to estimate subhazard ratios associating race/ethnicity with each outcome. Estimates were adjusted for sociodemographic factors and maternal morbidities. Data were analyzed from September 5, 2017, to May 21, 2018. Main Outcomes and Measures: Four morbidity outcomes were defined using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes: necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia, and retinopathy of prematurity. Results: In total, 582 297 infants were included in this study. Of these infants, 285 006 were female (48.9%) and 297 291 were male (51.0%). Using the conventional approach in the very preterm birth subcohort, black compared with white infants had an increased risk of only bronchopulmonary dysplasia (adjusted risk ratio [aRR], 1.34; 95% CI, 1.09-1.64) and a borderline increased risk of necrotizing enterocolitis (aRR, 1.39; 95% CI, 1.00-1.93). Hispanic infants had a borderline increased risk of necrotizing enterocolitis (aRR, 1.39; 95% CI, 0.98-1.96), and Asian infants had an increased risk of retinopathy of prematurity (aRR, 1.85; 95% CI, 1.15-2.97). In the fetuses-at-risk analysis, black infants had a 4.40 times higher rate of necrotizing enterocolitis (95% CI, 2.98-6.51), a 2.73 times higher rate of intraventricular hemorrhage (95% CI, 1.63-4.57), a 4.43 times higher rate of bronchopulmonary dysplasia (95% CI, 2.88-6.81), and a 2.98 times higher rate of retinopathy of prematurity (95% CI, 2.01-4.40). Hispanic infants had an approximately 2 times higher rate for all outcomes, and Asian infants had increased risk only for retinopathy of prematurity (adjusted hazard ratio, 2.43; 95% CI, 1.43-4.11). Conclusions and Relevance: In this study, racial/ethnic disparities in neonatal morbidities among very preterm infants appear to be sizable, but may have been underestimated in previous studies, and may have implications for the future. Understanding these racial/ethnic disparities is important, as they may contribute to inequalities in health and development later in the child's life. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/30208467/Association_of_Race/Ethnicity_With_Very_Preterm_Neonatal_Morbidities_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.2029 DB - PRIME DP - Unbound Medicine ER -