Racial Segregation and Intraventricular Hemorrhage in Preterm Infants

Abstract

BACKGROUND: Intraventricular hemorrhage (IVH) disproportionately affects black neonates. Other conditions that are more common in black neonates, including low birth weight and preterm delivery, have been linked with residential racial segregation (RRS). In this study, we investigated the association between RRS and IVH. METHODS: A retrospective cohort of neonates born between 24 and 32 weeks' gestation was constructed by using birth certificates linked to medical records from California, Missouri, and Pennsylvania between 1995 and 2009. Dissimilarity, a measure of RRS indicating the proportion of minorities in the census tract of the mother in comparison to the larger metropolitan area, was linked to patient data, yielding a cohort of 70 775 infants. Propensity score analysis matched infants born to mothers living in high segregation to those living in less segregated areas on the basis of race, sociodemographic factors, and medical comorbidities to compare the risk of developing IVH. RESULTS: Infants born to mothers in the most segregated quartile had a greater risk of developing IVH compared with those in the lowest quartile (12.9% vs 10.4%; P , .001). In 17 918 pairs matched on propensity scores, the risk of developing IVH was greater in the group exposed to a segregated environment (risk ratio = 1.08, 95% confidence interval: 1.01-1.15). This effect was stronger for black infants alone (risk ratio = 1.16; 95% confidence interval: 1.03-1.30). CONCLUSIONS: RRS is associated with an increased risk of IVH in preterm neonates, but the effect size varies by race. This association persists after balancing for community factors and birth weight, representing a novel risk factor for IVH.

Racial and Economic Neighborhood Segregation, Site of Delivery, and Morbidity and Mortality in Neonates Born Very Preterm

“…Murosko et al recently reported an association between racial segregation of metropolitan areas with risk of intraventricular hemorrhage among infants born very preterm. 27 Our analysis goes a step further and suggests that hospital care is a mechanism by which structural racism influences VPTB neonatal mortality and morbidity, even after accounting for patient case-mix.…”

Structural racism is associated with adverse postnatal outcomes among Black preterm infants

“…Redlining, an example of a structurally racist policy, and the resultant segregation in the U.S. have been associated with poor perinatal outcomes, including preterm birth, low birthweight, low Apgar scores, increased likelihood of NICU admission, and preterm comorbidities like intraventricular hemorrhage. 13,17,[32][33][34][35][36][37] Structural racism as measured by ICE has been associated with perinatal outcomes including PTB and IMR. 15 Fewer studies link structural racism and postnatal outcomes for preterm infants; we identified one study describing an association between neighborhood inequality and emergency department utilization for NICU graduates.…”

Race, language, and neighborhood predict high-risk preterm Infant Follow Up Program participation

“…Prior studies have identified that, compared to infants born to white mothers, preterm infants born to Black mothers have increased rates of NICU co-morbidities that are associated with poorer neurodevelopmental and functional outcomes, such as severe intraventricular hemorrhage. 29 – 31 The racial disparity in IFUP participation we identified suggests that the infants at highest risk for poor outcomes – infants born to Black mothers – are also those that are least likely to participate in IFUP. From a life-course perspective, differential access to, and participation in, recommended post-discharge health services might act to perpetuate or even amplify disparities in NICU-related health outcomes through childhood and early adulthood.…”