Inequities Along the Early Intervention Care Cascade for Very Preterm Infants

Area of Science:

• Neonatal Development
• Public Health
• Health Equity

Background:

• Infants born before 32 weeks gestation face higher risks for developmental and functional issues.
• Early Intervention programs support at-risk infants, but disparities may affect access to services like Individualized Family Service Plans (IFSPs).

Purpose of the Study:

• To identify and quantify inequities within the Early Intervention Care Cascade for very preterm infants.
• To determine where disparities occur in the process from referral to IFSP attainment.

Main Methods:

• A longitudinal cohort study analyzed data from 7169 very preterm infants (born <32 weeks gestation) in Massachusetts (2012-2019).
• The Early Intervention Care Cascade steps (referral, evaluation, IFSP) were modeled using sequential logistic regression, adjusting for infant and family factors.

Main Results:

• Racial and ethnic minority infants were less likely to be referred, evaluated, and receive an IFSP compared to non-Hispanic White infants.
• Non-Hispanic Black infants showed lower odds for evaluation (aOR, 0.57) and IFSP receipt (aOR, 0.83) versus non-Hispanic White infants.
• Observed associations were reduced after adjusting for social variables, indicating a complex interplay of factors.

Conclusions:

• Significant inequities and attrition exist in the Early Intervention Care Cascade for very preterm infants.
• Targeted structural interventions are crucial at each stage to close the equity gap in developmental support services.