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Published on: January 12, 2018
Racial and Ethnic Disparities in Preterm Infant Mortality and Severe Morbidity: A Population-Based Study
James G Anderson1, Elizabeth E Rogers, Rebecca J Baer
1Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
Insights
Racial disparities in preterm infant outcomes vary by gestational age. Black infants had lower mortality at very early gestations but higher rates at later gestations compared to white infants.
Area of Science:
- Neonatalogy
- Perinatal Health
- Health Disparities Research
Background:
- Significant racial/ethnic disparities exist in preterm birth and infant mortality rates.
- Limited research has explored race/ethnicity's specific impact on premature infant outcomes.
Purpose of the Study:
- To analyze mortality and severe neonatal morbidity rates in preterm infants.
- To stratify these outcomes by race/ethnicity across various gestational age groups.
Main Methods:
- Retrospective cohort study using linked birth, hospital, readmission, and death records (2007-2012).
- Included live-born infants born at or before 36 weeks gestational age.
- Analyzed self-identified maternal race/ethnicity and ICD-9 codes for morbidities, adjusting for confounders.
Main Results:
- Black infants (22-25 weeks) showed lower mortality than white infants (OR 0.76).
- Black infants (32-36 weeks) had higher mortality (OR 1.64-1.57).
- Hispanic infants (35-36 weeks) had lower mortality (OR 0.66); racial disparities in severe morbidities were also observed.
Conclusions:
- Race/ethnicity significantly impacts preterm infant mortality and severe morbidity.
- These disparities are gestational age-dependent and persist after adjusting for confounders.
Background:
Disparities exist in the rates of preterm birth and infant mortality across different racial/ethnic groups. However, only a few studies have examined the impact of race/ethnicity on the outcomes of premature infants.
Objective:
To report the rates of mortality and severe neonatal morbidity among multiple gestational age (GA) groups stratified by race/ethnicity.
Methods:
A retrospective cohort study utilizing linked birth certificate, hospital discharge, readmission, and death records up to 1 year of life. Live-born infants ≤36 weeks born in the period 2007-2012 were included. Maternal self-identified race/ethnicity, as recorded on the birth certificate, was used. ICD-9 diagnostic and procedure codes captured neonatal morbidities (intraventricular hemorrhage, retinopathy of prematurity, periventricular leukomalacia, bronchopulmonary dysplasia, and necrotizing enterocolitis). Multiple logistic regression was performed to evaluate the impact of race/ethnicity on mortality and morbidity, adjusting for GA, birth weight, sex, and multiple gestation.
Results:
Our cohort totaled 245,242 preterm infants; 26% were white, 46% Hispanic, 8% black, and 12% Asian. At 22-25 weeks, black infants were less likely to die than white infants (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.62-0.94). However, black infants born at 32-34 weeks (OR 1.64; 95% CI 1.15-2.32) or 35-36 weeks (OR 1.57; 95% CI 1.00-2.24) were more likely to die. Hispanic infants born at 35-36 weeks were less likely to die than white infants (OR 0.66; 95% CI 0.50-0.87). Racial disparities at different GAs were also detected for severe morbidities.
Conclusions:
The impact of race/ethnicity on mortality and severe morbidity varied across GA categories in preterm infants. Disparities persisted even after adjusting for important potential confounders.
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