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Racial identification represents significant risk factor for healthcare disparity among patients with severe
Adam Ahmad Karkoutli1, Madhav Kc2, Muhammad Jawla3
1Louisiana State University Health Sciences Center - New Orleans, School of Medicine, New Orleans, LA, 70112, USA.
Insights
Infants with severe bronchopulmonary dysplasia (BPD) requiring tracheostomy were disproportionately from African American or Black families. This racial disparity impacts readmission times and resource availability, necessitating further investigation for equitable healthcare delivery.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Health Equity
Background:
- Severe bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants.
- Tracheostomy is a procedure sometimes required for infants with severe BPD to aid breathing.
- Understanding the characteristics of this patient population is crucial for improving care.
Purpose of the Study:
- To characterize infants with severe BPD requiring tracheostomy.
- To identify disparities in this population within a tertiary level 4 NICU.
- To find targets for enhancing healthcare delivery.
Main Methods:
- Retrospective review of medical records for patients under 2 years old with severe BPD and tracheostomy.
- Comparison with a 4-year aggregate NICU patient demographic control group.
- Collection of demographic, maternal, clinical, and outcome data.
Main Results:
- A statistically significant difference was found in racial identification between the groups (p=0.036).
- African American or Black infants showed higher rates of tracheostomy for severe BPD.
- Differences noted in illicit drug use, birth measurements, readmission timing, and Child Opportunity Index scores based on race.
Conclusions:
- The incidence of tracheostomy in severe BPD was significantly higher in African American or Black infants.
- Caucasian or White infants had shorter readmission times.
- Poorer resources (COI) were observed for African American or Black infants, indicating a need for further research into racial disparities in BPD care.
Objectives:
To characterize the patient population with severe bronchopulmonary dysplasia (BPD) requiring tracheostomy in a large tertiary level 4 neonatal intensive care unit (NICU) and to identify potential targets for improvement in the delivery of high-quality healthcare.
Methods:
An IRB-exempt but IRB-registered retrospective review of medical records. Study inclusion criteria: patients treated for severe BPD with tracheostomy under 2 years of age in our tertiary referral center NICU. Control group criteria: 4-year aggregate NICU patient demographics. Basic demographics, maternal history, clinical data points, and outcomes variables were collected.
Results:
There was a statistically significant difference between the two groups in only one variable: racial identification (p-value = 0.036). All data points were then analyzed against racial identification, and statistically significant differences appeared in 4 categories: 1) illicit drug use, 2) birth head circumference and length, 3) days to readmission, and 4) child opportunity index scores. There was not a statistically significant difference in any other maternal characteristics or medical comorbidities, NICU length of stay, age at tracheostomy, or decannulation status.
Conclusion:
The incidence of our tracheostomy in infants with severe BPD was significantly higher (p = 0.036) in the subjects whose families identified as racially African American or Black, a marked contrast to our general NICU population and our overall tracheostomy population. The timing of the first readmission to the hospital was shorter for Caucasian or White infants compared to African American or Black infants. COI demonstrated statistically significantly poorer resources for African American or Black infants compared to White infants with tracheostomy. All other perinatal and outcome measurements did not differ significantly between the two racial groups. This suggests that this racial disparity is present and needs further investigation to better assess its impact on risk and outcomes as we develop pathways for high-quality healthcare delivery.
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