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Cross-Sectional Analysis on Racial and Economic Disparities Affecting Mortality in Preterm Infants with
Diana L Jin1, Eisha A Christian1, Frank Attenello1
1Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA.
Insights
Black and Medicaid-insured preterm infants with posthemorrhagic hydrocephalus face higher mortality. These disparities persist independently, highlighting critical areas for further research in infant health outcomes.
Area of Science:
- Neonatal neurology
- Public health
- Health disparities
Background:
- Racial and socioeconomic disparities significantly impact healthcare outcomes, particularly infant mortality.
- Black neonates exhibit higher mortality rates compared to Hispanic and white neonates.
- The management of neurological complications in preterm infants may contribute to these disparities.
Purpose of the Study:
- To investigate racial and socioeconomic disparities in mortality among preterm infants diagnosed with posthemorrhagic hydrocephalus (PHH).
Main Methods:
- Utilized data from the Nationwide Inpatient Sample and Kids Inpatient Database (2000-2010).
- Included preterm infants with intraventricular hemorrhage and PHH, identified by ICD-9-CM codes.
- Employed multivariate analysis to control for patient, hospital, and admission factors, calculating relative risk (RR) ratios for mortality and other outcomes.
Main Results:
- Black neonates showed increased mortality (RR=1.47) compared to white and Hispanic infants, despite fewer cardiac and gastrointestinal complications.
- Preterm infants with Medicaid insurance had higher mortality (RR=1.2) than those with private insurance.
- Both race and insurance status independently predicted increased mortality.
Conclusions:
- Black infants and those insured by Medicaid experience significantly higher mortality rates when suffering from intraventricular hemorrhage and PHH.
- These mortality risks associated with race and insurance are independent.
- Further research is essential to elucidate the factors driving these persistent racial and socioeconomic disparities in infant mortality.
Background:
Despite major advances in medicine, racial and socioeconomic disparities continue to affect health care outcomes. Higher overall infant mortality has been reported for black neonates compared with their Hispanic and white counterparts. The underlying basis for these differences remains unclear. A potential influencing factor is the management of premature neurologic complications in this disadvantaged group. This study examines racial and socioeconomic disparities on mortality in preterm infants with posthemorrhagic hydrocephalus (PHH).
Methods:
Data from the Nationwide Inpatient Sample and Kids Inpatient Database were combined from 2000 to 2010. Discharges with International Classification of Diseases, Ninth Revision, Clinical Modification codes for preterm births with intraventricular hemorrhage and PHH were included. Relative risk (RR) ratios for mortality, complications, length of stay, and hospital costs were obtained with multivariate analysis after controlling for patient-level, hospital-level, and admission-level factors.
Results:
When controlling for patient and hospital factors, black neonates had increased mortality compared with whites and Hispanics (RR = 1.47; P < 0.01). This association existed despite lower rates of congenital cardiac defects (RR = 0.84; P < 0.01), gastrointestinal complications (RR = 0.84; P < 0.01), and general complications of prematurity (RR = 0.95; P = 0.04) in the black cohort. Preterm infants insured by Medicaid had increased mortality compared with those with private insurance (RR = 1.2; P = 0.04) after adjusting for patient and hospital factors.
Conclusions:
Among preterm infants with intraventricular hemorrhage and resultant PHH, black infants and those insured by Medicaid have significantly increased mortality but these 2 effects are independent. Further studies are needed to fully understand the factors affecting these racial and socioeconomic disparities.
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