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Association of Race/Ethnicity With Very Preterm Neonatal Morbidities

Teresa Janevic1,2,3, Jennifer Zeitlin3,4, Nathalie Auger5

  • 1Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York.

JAMA Pediatrics
|September 13, 2018
PubMed

Insights

Racial and ethnic disparities in severe neonatal morbidities among very preterm infants are significant. A fetuses-at-risk analysis revealed substantially higher rates for Black and Hispanic infants compared to White infants, suggesting prior studies may have underestimated these differences.

Area of Science:

  • Neonatal research
  • Perinatal epidemiology
  • Health disparities

Background:

  • Severe morbidities in very preterm infants have long-term health implications.
  • Existing research on racial/ethnic disparities in these morbidities is limited and may underestimate true differences due to analytical methods.

Purpose of the Study:

  • To quantify racial/ethnic differences in severe neonatal morbidities among very preterm infants.
  • To compare findings using conventional and fetuses-at-risk analytical approaches.

Main Methods:

  • Population-based retrospective cohort study in New York City (2010-2014).
  • Included 582,297 infants; excluded those born before 24 weeks' gestation, with congenital anomalies, or missing data.
  • Utilized linked birth, mortality, and hospital discharge data; analyzed four morbidities (necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia, retinopathy of prematurity) using log-binomial and Cox proportional hazards regression (fetuses-at-risk analysis).

Main Results:

  • Conventional analysis showed modest disparities: Black infants had higher risks for bronchopulmonary dysplasia and borderline increased risk for necrotizing enterocolitis; Hispanic infants had borderline increased risk for necrotizing enterocolitis; Asian infants had increased risk for retinopathy of prematurity.
  • Fetuses-at-risk analysis revealed substantially higher rates: Black infants had 2.73-4.43 times higher rates for all four morbidities; Hispanic infants had approximately 2 times higher rates for all outcomes.
  • Asian infants showed increased risk for retinopathy of prematurity in the fetuses-at-risk analysis.

Conclusions:

  • Racial/ethnic disparities in severe neonatal morbidities among very preterm infants are substantial and likely underestimated by conventional analyses.
  • The fetuses-at-risk approach highlights significant differences, particularly for Black and Hispanic infants.
  • Addressing these disparities is crucial for improving long-term health equity in this vulnerable population.
Abstract

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