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Neonatal mortality is higher in US hospitals with higher proportion of black babies

BMJ 2005; 331 doi: (Published 01 December 2005) Cite this as: BMJ 2005;331:1291
  1. David Spurgeon
  1. Quebec

    Mortality among neonates is significantly higher in hospitals that have a higher percentage of very low birthweight babies who are black, a study has found.

    The researchers found that neonatal mortality was higher among black and white infants at hospitals where 35% of very low birthweight infants were black than at hospitals where less than 15% of very low birthweight infants were black (American Journal of Public Health 2005;95:2206-12).

    Leo Morales, the lead author and associate professor of general internal medicine and health services research at the David Geffen School of Medicine at the University of California in Los Angeles, said: “This study points to a possible explanation for that disparity: namely that hospitals where the majority of black infants [in the neighbourhood] are born do not provide the same quality of care as hospitals where the majority of white infants are born.”

    Mortality in the first 28 days of life fell significantly in the United States between 1940 and 2000—from 28.8 deaths to 4.6 deaths per 1000 live births—but ethnic disparities persisted or increased during that period. Deaths among very low birthweight infants (those weighing between 501 g and 1500 g) account for more than half of deaths among US infants a year.

    The researchers analysed medical records that were linked to secondary data sources for 74 050 black and white infants with very low birthweight. The infants were treated at 332 hospitals participating in the Vermont Oxford network from 1995 to 2000. Hospitals where more than 35% of the treated infants were black were defined as minority serving hospitals.

    They found that, compared with hospitals where less than 15% of the very low birthweight infants were black, minority serving hospitals had a significantly higher risk adjusted neonatal mortality (white infants: odds ratio 1.3 (95% confidence interval 1.09 to 1.56); black infants: odds ratio 1.29 (1.01 to 1.64); pooled odds ratio 1.28 (1.1 to 1.5)). Higher neonatal mortality in minority serving hospitals could not be explained by factors relating to the hospitals or to treatment.

    The researchers say the next step in explaining the disparity is to investigate aspects such as socioeconomic status of infants, characteristics of doctors and nursing staffing, and other characteristics relating to the hospitals.

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