Black-White Differences in Neonatal Survival Among Periviable Births, 1995-2019
Allison Stolte1, Brenda Bustos, Alison Gemmill
1Department of Sociology, University of Virginia, Charlottesville, Virginia; the Department of Health, Society, and Behavior, Joe C. Wen School of Population and Public Health, and the Center for Population, Inequality, and Policy, University of California, Irvine, Irvine, the Department of Epidemiology, University of California, Los Angeles, Los Angeles, and the School of Public Health, University of California, Berkeley, Berkeley, California; and the Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington.
While neonatal survival improved for both Black and White periviable births, White infants saw faster declines in death risks. This slower improvement for Black infants means they still bear a disproportionate burden of periviable deaths.
Area of Science:
- Perinatal epidemiology
- Neonatal mortality research
- Racial disparities in healthcare
Background:
- Previous research indicated a neonatal survival advantage for Black periviable births compared to White births.
- Racial disparities in healthcare access and outcomes are a significant public health concern.
- Periviable births (20 0/7-25 6/7 weeks of gestation) represent a critical period for neonatal survival.
Purpose of the Study:
- To determine if the neonatal survival advantage for Black periviable births persisted from 1995 to 2019 in the U.S.
- To quantify the changes in neonatal survivability for Black and White periviable births over this 25-year period.
- To analyze race as a marker for exposure to racialized stressors and healthcare barriers impacting neonatal outcomes.
Main Methods:
- Population-based observational study utilizing U.S. National Center for Health Statistics data (1995-2019).
- Inclusion of non-Hispanic Black (n=149,601) and non-Hispanic White (n=158,500) periviable births.
- Modified Poisson regressions used to estimate neonatal death risks, controlling for sociodemographic and pregnancy characteristics.
Main Results:
- In 1995-1999, Black periviable neonates had a survival advantage (aRR 0.86).
- From 2015-2019, White periviable neonates showed greater risk reduction (aRR 0.82) compared to Black neonates (slower improvement, Black×period aRR 1.07).
- Neonatal death risks declined by 18% for White infants versus 13% for Black infants; Black-White risk ratios ranged from 4.0 to 3.6.
Conclusions:
- Both Black and White periviable births experienced reduced neonatal death risks between 1995 and 2019.
- White periviable births demonstrated faster declines in neonatal death risks compared to Black periviable births.
- Despite overall improvements, slower survival gains for Black periviable neonates sustain a disproportionate mortality burden due to their overrepresentation in periviable deliveries.
Related Concept Videos
Comparing the Survival Analysis of Two or More Groups
Regression Toward the Mean
Assumptions of Survival Analysis
