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Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm
Jeffrey D Horbar1,2, Erika M Edwards1,2,3, Lucy T Greenberg1
1Vermont Oxford Network, Burlington.
JAMA Pediatrics
|March 26, 2019
Summary
Racial and ethnic minority infants experience significant segregation across neonatal intensive care units (NICUs) in the US. Black infants disproportionately receive care in lower-quality NICUs, while Hispanic and Asian infants are in higher-quality units.
Area of Science:
- Neonatal care
- Health equity
- Healthcare disparities
Background:
- Racial and ethnic minorities in the US receive lower-quality healthcare compared to white non-Hispanic individuals.
- The role of neonatal intensive care unit (NICU) location in the quality of care for minority infants is not well understood.
Purpose of the Study:
- To quantify the extent of segregation and care inequality for very low-birth-weight and very preterm infants across US NICUs.
- To analyze racial and ethnic disparities in NICU quality of care.
Main Methods:
- A cohort study analyzed 117,982 infants (black, Hispanic, Asian, white) across 743 NICUs in the Vermont Oxford Network from 2014-2016.
- NICU segregation and inequality indices were calculated using Gini coefficients, comparing minority infants to white infants.
- NICUs were ranked by the proportion of white infants for segregation and by the Baby-MONITOR score for inequality.
Main Results:
- Significant segregation was observed: NICU segregation index values ranged from 0.45 (Asian) to 0.58 (Hispanic).
- Black infants were concentrated in lower-quality NICUs (NICU inequality index: 0.07), while Hispanic (-0.10) and Asian (-0.26) infants were in higher-quality NICUs.
- Regional variations in NICU quality were substantial, explaining inequality for Hispanic infants but not for black or Asian infants.
Conclusions:
- Racial and ethnic segregation exists across US NICUs, mirroring broader societal segregation.
- After accounting for regional differences, black infants received care in lower-quality NICUs compared to white infants.
- Further research is needed on sociodemographic factors and public policies influencing hospital quality, access, and choice for minority mothers and infants.
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