Racial and Ethnic Differences Over Time in Outcomes of Infants Born Less Than 30 Weeks' Gestation

Abstract

Objectives: To examine changes in care practices over time by race and ethnicity and whether the decrease in hospital mortality and severe morbidities has benefited infants of minority over infants of white mothers.

Methods: Infants 22 to 29 weeks' gestation born between January 2006 and December 2017 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals for African American and Hispanic versus white infants by birth year. We tested temporal differences in mortality and morbidity rates between white and African American or Hispanic infants using a likelihood ratio test on nested binomial regression models.

Results: Disparities for certain care practices such as antenatal corticosteroids and for some in-hospital outcomes have narrowed over time for minority infants. Compared with white infants, African American infants had a faster decline for mortality, hypothermia, necrotizing enterocolitis, and late-onset sepsis, whereas Hispanic infants had a faster decline for mortality, respiratory distress syndrome, and pneumothorax. Other morbidities showed a constant rate difference between African American and Hispanic versus white infants over time. Despite the improvements, outcomes including hypothermia, mortality, necrotizing enterocolitis, late-onset sepsis, and severe intraventricular hemorrhage remained elevated by the end of the study period, especially among African American infants.

Conclusions: Racial and ethnic disparities in vital care practices and certain outcomes have decreased. That the quality deficit among minority infants occurred for several care practice measures and potentially modifiable outcomes suggests a critical role for quality improvement initiatives tailored for minority-serving hospitals.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Copyright © 2019 by the American Academy of Pediatrics.

Figures

FIGURE 1

Rates of DR practices among white, African American, and Hispanic infants by birth year. The blue line represents white infants, the red line represents African American infants, and the green line represents Hispanic infants; borders represent 95% CIs.

FIGURE 2

Rates of NICU practices among white, African American, and Hispanic infants by birth year. The blue line represents white infants, the red line represents African American infants, and the green line represents Hispanic infants; borders represent 95% CIs.

FIGURE 3

Rate differences in mortality and morbidity outcomes among African American and Hispanic versus white infants by birth year. The red line represents the rate difference among African American versus white infants, and the blue line represents the rate difference among Hispanic versus white infants; borders represent 95% CIs.