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Racial/Ethnic Disparities in Morbidity and Mortality for Preterm Neonates Admitted to a Tertiary Neonatal Intensive Care Unit

Abstract

Objective

The objective of this study was to assess whether in-hospital morbidity or mortality differed by race/ethnicity for preterm neonates admitted to the neonatal intensive care unit (NICU).

Study Design

In a retrospective cohort study, preterm infants, < 37 weeks, were admitted to the NICU from 1994 to 2009. Exclusions included structural anomalies and aneuploidy. Primary outcome was in-hospital mortality (IHM). Secondary outcomes were respiratory distress syndrome (RDS), interventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP). Sub-analysis of very preterm (VPT) infants, < 28 weeks, was performed. Five racial/ethnic groups (REGs) were compared: White, Black, Hispanic, Asian, and Mixed. Associations were modeled by logistic regression. White neonates (WNs) were the referent group. Unadjusted and adjusted odds ratios and 95% confidence intervals for remaining REGs were reported. p value was significant at 5% for overall tests and at Bonferroni-corrected level < 0.0125 for between-race comparisons with WNs.

Results

Four thousand nine hundred fifty-five preterm neonates were identified; 153 were excluded leaving 4802 for analysis. After controlling covariates that were chosen a priori, there was no difference across REGs for IHM (all between-race comparison p values > 0.0125). There was a significant difference in RDS among Black neonates (BNs) (aOR 0.57, 95% CI 0.45–0.73; p < 0.001) and Hispanic neonates (HNs) (aOR 0.67, 95% CI 0.50–0.89; p = 0.005) compared to WNs. The risk of ROP was significantly different across REGs with HNs having a 70% increase in ROP (aOR 1.70, 95% CI 1.15–2.49; p = 0.008) and Mixed neonates (MNs) experiencing a 55% reduction (aOR 0.45, 95% CI 0.29–0.68; p < 0.001) compared to WNs. There was no difference in IVH or NEC across REGs (all p values > 0.0125). In the VPT cohort sub-analysis, BNs experienced a significant 59% reduction in IHM compared to WNs (BNs aOR 0.41, 95% CI 0.22–0.73; p = 0.003). MNs experienced a 46% reduction in ROP compared to WNs (aOR 0.54, 95% CI 0.35–0.81; p = 0.004). There was no difference in RDS, IVH, or NEC in very preterm infants across REGs (all between comparison p values > 0.0125).

Conclusion

In preterm neonates, in-hospital mortality does not significantly differ across racial and ethnic groups. However, in very preterm infants, in-hospital mortality for Black neonates is improved. There are morbidity differences (RDS, ROP) seen among racial/ethnic groups.

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Abbreviations

RDS:

respiratory distress syndrome

IVH:

interventricular hemorrhage

NEC:

necrotizing enterocolitis

ROP:

retinopathy of prematurity

NICU:

neonatal intensive care unit

VPT:

very preterm

IHM:

in-hospital mortality

REGs:

racial and ethnic groups

WNs:

White neonates

BNs:

Black neonates

CCMC:

Connecticut Children’s Medical Center

aOR:

adjusted odds ratio

CI:

confidence intervals

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Correspondence to Courtney Townsel.

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Townsel, C., Keller, R., Kuo, CL. et al. Racial/Ethnic Disparities in Morbidity and Mortality for Preterm Neonates Admitted to a Tertiary Neonatal Intensive Care Unit. J. Racial and Ethnic Health Disparities 5, 867–874 (2018). https://doi.org/10.1007/s40615-017-0433-2

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Keywords

  • Health disparities
  • Racial disparities
  • Preterm infants
  • Very preterm infants
  • Mortality