Racial and Ethnic Disparities in Preterm Infant Mortality and Severe Morbidity: A Population-Based Study

Abstract

Background: Disparities exist in the rates of preterm birth and infant mortality across different racial/ethnic groups. However, only a few studies have examined the impact of race/ethnicity on the outcomes of premature infants. Objective: To report the rates of mortality and severe neonatal morbidity among multiple gestational age (GA) groups stratified by race/ethnicity. Methods: A retrospective cohort study utilizing linked birth certificate, hospital discharge, readmission, and death records up to 1 year of life. Live-born infants ≤36 weeks born in the period 2007-2012 were included. Maternal self-identified race/ethnicity, as recorded on the birth certificate, was used. ICD-9 diagnostic and procedure codes captured neonatal morbidities (intraventricular hemorrhage, retinopathy of prematurity, periventricular leukomalacia, bronchopulmonary dysplasia, and necrotizing enterocolitis). Multiple logistic regression was performed to evaluate the impact of race/ethnicity on mortality and morbidity, adjusting for GA, birth weight, sex, and multiple gestation. Results: Our cohort totaled 245,242 preterm infants; 26% were white, 46% Hispanic, 8% black, and 12% Asian. At 22-25 weeks, black infants were less likely to die than white infants (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.62-0.94). However, black infants born at 32-34 weeks (OR 1.64; 95% CI 1.15-2.32) or 35-36 weeks (OR 1.57; 95% CI 1.00-2.24) were more likely to die. Hispanic infants born at 35-36 weeks were less likely to die than white infants (OR 0.66; 95% CI 0.50-0.87). Racial disparities at different GAs were also detected for severe morbidities. Conclusions: The impact of race/ethnicity on mortality and severe morbidity varied across GA categories in preterm infants. Disparities persisted even after adjusting for important potential confounders.

Global Incidence of Necrotizing Enterocolitis: a Systematic Review and Meta-Analysis

“…Some regions had multiple studies other areas had none. A total of eight studies were reported from the United States covering a number of states including: California, Texas, Atlanta, Connecticut, and New York (3,6,9,(27)(28)(29)(30)(31). Multiple studies were also reported from the Europe including Poland, Romania, Finland, Belgium, Sweden and Switzerland (12,13,28,(32)(33)(34).…”

“…The publication year of the studies ranged from 1988 to 2019, but the majority were carried out after 2000. Some of the studies focused on evaluating a certain exposure (7,9,33,37), however, the data presented in these papers were not limited to the exposure groups and data from the general population was extracted to compute the incidence ( (28). Upon retrograde calculation of the number of NEC cases and dividing them by a total number of NICU preterm babies the incidence of NEC was 9.1%.…”

Risks of preterm birth among non‐Hispanic black and non‐Hispanic white women: Effect modification by maternal age

“…For weathering specifically, researchers often use white women in their twenties as the universal reference group, an approach that does not sufficiently account for the increased baseline risk of poor outcomes among black women at all ages, nor for the increasing risk of poor birth outcomes with advancing maternal age for all women. [25][26][27][28] Furthermore, age is frequently grouped into broad, uneven categories and fails to include women at the tails of the distribution (below 20 years or over 35 years), a particular shortcoming as childbearing patterns have shifted towards later initiation of births among US women. 29,30 In addition, many early studies included only limited adjustment for multiple confounders, especially maternal health conditions and measures of socio-economic status, which have demonstrated associations with poor birth outcomes.…”

Re-conceptualizing Associations between Race and Morbidities of Extreme Prematurity

“…Recent reports have investigated the relationship between race and BPD and respiratory outcomes following preterm birth. 7,8,[13][14][15][16][17] Implicit in many such investigations is the question as to whether genetic sequence differences between racial groups are responsible for differences in risk of diseases such as BPD.…”