Racial/Ethnic Disparity in NICU Quality of Care Delivery

Profit, Jochen; Gould, Jeffrey B.; Bennett, Mihoko V.; Goldstein, Benjamin A.; Draper, David; Phibbs, Ciaran S.; Lee, Henry

doi:10.1542/peds.2017-0918

Cited by 174 publications

(156 citation statements)

References 21 publications

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“…Still, even in low-performing NICUs in California, Asian infants often had higher scores than white infants. 29 Whether these patterns will be observed in other states and regions will be the topic of a future Vermont Oxford Network study. Additional research on factors that influence access, referral patterns, and hospital choice is required to fully understand the variation in inequality of NICU care among different cities, health care markets, states, and regions.…”

Section: Discussionmentioning

confidence: 98%

“…Baby-MONITOR, which was tested in samples of California NICUs, is a robust discriminator of quality of care delivery. 26,29 …”

Section: Methodsmentioning

confidence: 99%

“…Black and white infants scored differently on the process and outcome components of Baby-MONITOR. 29 A NICU quality score that weighted these components differently might change the quality rankings of NICUs. Finally, there are many unmeasured factors including neighborhood of residence, insurance coverage, immigration status, hospital location and financing, and public policies, among others, that could explain our findings.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants

et al. 2019

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IMPORTANCE Racial and ethnic minorities receive lower-quality health care than white non-Hispanic individuals in the United States. Where minority infants receive care and the role that may play in the quality of care received is unclear. OBJECTIVE To determine the extent of segregation and inequality of care of very low-birth-weight and very preterm infants across neonatal intensive care units (NICUs) in the United States. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 743 NICUs in the Vermont Oxford Network included 117 982 black, Hispanic, Asian, and white infants born at 401 g to 1500 g or 22 to 29 weeks’ gestation from January 2014 to December 2016. Analysis began January 2018. MAIN OUTCOMES AND MEASURES The NICU segregation index and NICU inequality index were calculated at the hospital level as the Gini coefficients associated with the Lorenz curves for black, Hispanic, and Asian infants compared with white infants, with NICUs ranked by proportion of white infants for the NICU segregation index and by composite Baby-MONITOR (Measure of Neonatal Intensive Care Outcomes Research) score for the NICU inequality index. RESULTS Infants (36 359 black [31%], 21 808 Hispanic [18%], 5920 Asian [5%], and 53 895 white [46%]) were segregated among the 743 NICUs by race and ethnicity (NICU segregation index: black: 0.50 [95% CI, 0.46–0.53], Hispanic: 0.58 [95% CI, 0.54–0.61], and Asian: 0.45 [95% CI, 0.40–0.50]). Compared with white infants, black infants were concentrated at NICUs with lower-quality scores, and Hispanic and Asian infants were concentrated at NICUs with higher-quality scores (NICU inequality index: black: 0.07 [95% CI, 0.02–0.13], Hispanic: −0.10 [95% CI, −0.17 to −0.04], and Asian: −0.26 [95% CI, −0.32 to −0.19]). There was marked variation among the census regions in weighted mean NICU quality scores (range: −0.69 to 0.85). Region of residence explained the observed inequality for Hispanic infants but not for black or Asian infants. CONCLUSIONS AND RELEVANCE Black, Hispanic, and Asian infants were segregated across NICUs, reflecting the racial segregation of minority populations in the United States. There were large differences between geographic regions in NICU quality. After accounting for these differences, compared with white infants, Asian infants received care at higher-quality NICUs and black infants, at lower-quality NICUs. Explaining these patterns will require understanding the effects of sociodemographic factors and public policies on hospital quality, access, and choice for minority women and their infants.

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Section: Discussionmentioning

confidence: 98%

“…Baby-MONITOR, which was tested in samples of California NICUs, is a robust discriminator of quality of care delivery. 26,29 …”

Section: Methodsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

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Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants

et al. 2019

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“…33,34 Variable access to 17-hydroxyprogesterone, antenatal steroids, prenatal ultrasonography, and early treatment and/or management of preterm prolonged rupture of membranes and/or signs of infection may be contributing to racial disparities in preterm birth rates. 35,36 In addition, lack of adequate prenatal care may delay appropriate management of conditions that develop before and during pregnancies, such as diabetes, hypertension, preeclampsia, and others. 23 Since the birth of the first US infant conceived with assisted reproductive technology (ART) in 1981, the use of advanced technologies to overcome infertility has resulted in millions of pregnancies and subsequent live births.…”

Section: Pathogenesis Of Preterm Birthsmentioning

confidence: 99%

Updates on an At-Risk Population: Late-Preterm and Early-Term Infants

Stewart

Barfield

Newborn³

2019

Pediatrics

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and organizations (March of Dimes) initiated nationwide monitoring and educational plans that had a significant effect on decreasing the rates of iatrogenic LPT deliveries. However, there is now an evolving concern. After nearly a decade of steady decreases in the LPT birth rate that largely contributed to the decline in total US preterm birth rates, the birth rate in LPT infants has been inching upward since 2015. In addition, evidence revealed by strong population health research demonstrates that being born as an early-term infant poses a significant risk to an infant' s survival, growth, and development. In this report, we summarize the initial progress and discuss the potential reasons for the current trends in LPT and early-term birth rates and propose research recommendations.

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“…One area of focus has been differences in the types of care (or quality of care) that patients from minority racial/ethnic groups receive compared with non-Hispanic white patients. Profit et al 1 provide new evidence of this potential issue as applied to perinatal medicine. By using data from >100 perinatal hospitals in California, the authors document substantial differences in the care quality received by non-Hispanic African American and Hispanic patients compared with non-Hispanic white patients.…”

mentioning

confidence: 99%