Socioeconomic factors play an important but complex role in PTB disparities. The absence of Black-White disparities in PTB within certain socioeconomic subgroups, alongside substantial disparities within others, suggests that social factors moderate the disparity. Further research should explore social factors suggested by the literature-including life course socioeconomic experiences and racism-related stress, and the biological pathways through which they operate-as potential contributors to PTB among Black and White women with different levels of social advantage.

Key Points Question Does a safety-net hospital definition based on uncompensated care identify different types of hospitals compared with other definitions? Findings In this cross-sectional study of 2066 hospitals, the Medicare Disproportionate Share Hospital index identified larger teaching safety-net hospitals, whereas a definition based on uncompensated care captured smaller, rural safety-net hospitals at greater financial risk. Bad debt and charity care were approximately twice as high for safety-net hospitals as for non–safety-net hospitals, unreimbursed costs were 38% higher, and operating margins were more than 6 times lower. Meaning Medicare Disproportionate Share Hospital payment formulas are evolving to emphasize uncompensated care, and hospitals may experience funding changes as a result.

Our results indicate that hospital characteristics contribute to higher rates of sepsis mortality for blacks and Hispanics. These findings underscore the importance of ensuring that improved sepsis identification and management is implemented across all hospitals, especially those serving diverse populations.