Racial/Ethnic Disparities Among Extremely Preterm Infants in the United States From 2002 to 2016

Colm P Travers; Waldemar A Carlo; Scott A McDonald; Abhik Das; Namasivayam Ambalavanan; Edward F Bell; Pablo J Sánchez; Barbara J Stoll; Myra H Wyckoff; Abbot R Laptook; Krisa P Van Meurs; Ronald N Goldberg; Carl T D'Angio; Seetha Shankaran; Sara B DeMauro; Michele C Walsh; Myriam Peralta-Carcelen; Monica V Collins; M Bethany Ball; Ellen C Hale; Nancy S Newman; Jochen Profit; Jeffrey B Gould; Scott A Lorch; Carla M Bann; Margarita Bidegain; Rosemary D Higgins; Generic Database and Follow-up Subcommittees of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

doi:10.1001/jamanetworkopen.2020.6757

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Racial/Ethnic Disparities Among Extremely Preterm Infants in the United States From 2002 to 2016

Journal article

Open access

Peer reviewed

Racial/Ethnic Disparities Among Extremely Preterm Infants in the United States From 2002 to 2016

Colm P Travers, Waldemar A Carlo, Scott A McDonald, Abhik Das, Namasivayam Ambalavanan, Edward F Bell, Pablo J Sánchez, Barbara J Stoll, Myra H Wyckoff, Abbot R Laptook, …

JAMA network open, Vol.3(6), pp.e206757-e206757

06/01/2020

DOI: 10.1001/jamanetworkopen.2020.6757

PMCID: PMC7287569

PMID: 32520359

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Abstract

Racial/ethnic disparities in quality of care among extremely preterm infants are associated with adverse outcomes. To assess whether racial/ethnic disparities in major outcomes and key care practices were changing over time among extremely preterm infants. This observational cohort study used prospectively collected data from 25 US academic medical centers. Participants included 20 092 infants of 22 to 27 weeks' gestation with a birth weight of 401 to 1500 g born at centers participating in the National Institute of Child Health and Human Development Neonatal Research Network from 2002 to 2016. Of these infants, 9316 born from 2006 to 2014 were eligible for follow-up at 18 to 26 months' postmenstrual age (excluding 5871 infants born before 2006, 2594 infants born after 2014, and 2311 ineligible infants including 64 with birth weight >1000 g and 2247 infants with gestational age >26 6/7 weeks), of whom 745 (8.0%) did not have known follow-up outcomes at 18 to 26 months. Rates of mortality, major morbidities, and care practice use over time were evaluated using models adjusted for baseline characteristics, center, and birth year. Data analyses were conducted from 2018 to 2019. In total, 20 092 infants with a mean (SD) gestational age of 25.1 (1.5) weeks met the inclusion criteria and were available for the primary outcome: 8331 (41.5%) black infants, 3701 (18.4%) Hispanic infants, and 8060 (40.1%) white infants. Hospital mortality decreased over time in all groups. The rate of improvement in hospital mortality over time did not differ among black and Hispanic infants compared with white infants (black infants went from 35% to 24%, Hispanic infants went from 32% to 27%, and white infants went from 30% to 22%; P = .59 for race × year interaction). The rates of late-onset sepsis among black infants (went from 37% to 24%) and Hispanic infants (went from 45% to 23%) were initially higher than for white infants (went from 36% to 25%) but decreased more rapidly and converged during the most recent years (P = .02 for race × year interaction). Changes in rates of other major morbidities did not differ by race/ethnicity. Death before follow-up decreased over time (from 2006 to 2014: black infants, 14%; Hispanic infants, 39%, white infants, 15%), but moderate-severe neurodevelopmental impairment increased over time in all racial/ethnic groups (increase from 2006 to 2014: black infants, 70%; Hispanic infants, 123%; white infants, 130%). Rates of antenatal corticosteroid exposure (black infants went from 72% to 90%, Hispanic infants went from 73% to 83%, and white infants went from 86% to 90%; P = .01 for race × year interaction) and of cesarean delivery (black infants went from 45% to 59%, Hispanic infants went from 49% to 59%, and white infants went from 62% to 63%; P = .03 for race × year interaction) were initially lower among black and Hispanic infants compared with white infants, but these differences decreased over time. Among extremely preterm infants, improvements in adjusted rates of mortality and most major morbidities did not differ by race/ethnicity, but rates of neurodevelopmental impairment increased in all groups. There were narrowing racial/ethnic disparities in important care practices, including the use of antenatal corticosteroids and cesarean delivery.

Adrenal Cortex Hormones - adverse effects

Birth Weight

Case-Control Studies

Cesarean Section - statistics & numerical data

Child Health - ethnology

Child Health - trends

Cohort Studies

Ethnicity

Female

Gestational Age

Healthcare Disparities - ethnology

Hospital Mortality - trends

Humans

Infant, Extremely Premature

Infant, Newborn

Morbidity - trends

Neurodevelopmental Disorders - epidemiology

Neurodevelopmental Disorders - ethnology

Pregnancy

Prenatal Care

Prospective Studies

United States - ethnology

Details

Title: Subtitle: Racial/Ethnic Disparities Among Extremely Preterm Infants in the United States From 2002 to 2016
Creators: Colm P Travers - University of Alabama at Birmingham
Waldemar A Carlo - University of Alabama at Birmingham
Scott A McDonald - RTI International
Abhik Das - International Epidemiology Institute
Namasivayam Ambalavanan - University of Alabama at Birmingham
Edward F Bell - University of Iowa
Pablo J Sánchez - Nationwide Children's Hospital
Barbara J Stoll - Grady Memorial Hospital
Myra H Wyckoff - The University of Texas Southwestern Medical Center
Abbot R Laptook - Women & Infants Hospital of Rhode Island
Krisa P Van Meurs - Lucile Packard Children's Hospital
Ronald N Goldberg - Duke University
Carl T D'Angio - University of Rochester
Seetha Shankaran - Wayne State University
Sara B DeMauro - Children's Hospital of Philadelphia
Michele C Walsh - Case Western Reserve University
Myriam Peralta-Carcelen - University of Alabama at Birmingham
Monica V Collins - University of Alabama at Birmingham
M Bethany Ball - Lucile Packard Children's Hospital
Ellen C Hale - Grady Memorial Hospital
Nancy S Newman - Case Western Reserve University
Jochen Profit - Lucile Packard Children's Hospital
Jeffrey B Gould - Lucile Packard Children's Hospital
Scott A Lorch - Children's Hospital of Philadelphia
Carla M Bann - RTI International
Margarita Bidegain - Duke University
Rosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human Development
Generic Database and Follow-up Subcommittees of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Resource Type: Journal article
Publication Details: JAMA network open, Vol.3(6), pp.e206757-e206757
DOI: 10.1001/jamanetworkopen.2020.6757
PMID: 32520359
PMCID: PMC7287569
NLM abbreviation: JAMA Netw Open
ISSN: 2574-3805
eISSN: 2574-3805
Grant note: U24 HD095254 / NICHD NIH HHS UG1 HD027904 / NICHD NIH HHS U10 HD027904 / NICHD NIH HHS
Language: English
Date published: 06/01/2020
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984353881402771

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