Race, Hospital, and Premature Babies Outcomes
Mount Sinai Researchers Find Differences in Very Preterm Infant Morbidity and Mortality Rates among New York City Hospitals
Among very premature infants, black and Hispanic babies are more likely than white babies to be born at hospitals with higher rates of death and complications, researchers at the Icahn School of Medicine at Mount Sinai report. These differences in hospital quality are an important and potentially modifiable cause of racial disparities in neonatal deaths and severe complications.
The study, titled “Differences in Morbidity and Mortality Rates in Black, White and Hispanic Very Preterm Infants Among New York City Hospitals,” was published in an online study today in JAMA Pediatrics. For a video about this study click here.
The Mount Sinai researchers found that very premature black and Hispanic infants were more likely to be born at hospitals with higher risk-adjusted neonatal morbidity-mortality rates, and that these differences contributed to excess morbidity and mortality among the black and Hispanic infants. These differences in hospital of birth explained 39.9 percent of the black-white disparity and 29.5 percent of the Hispanic-white disparity in outcomes.
According to Elizabeth Howell, MD, Director of the Women’s Health Institute, Icahn School of Medicine at Mount Sinai, and lead author of the study, neonatal care has improved substantially over the past decade, yet racial and ethnic disparities in morbidity and mortality continue.
“It is very important to seriously think about the cause for the severe preterm babies’ morbidities and how it will affect these children later on in life,” said Dr. Howell. “When a baby is born prematurely, many complications can occur—they can have problems with their lungs, eyes, intestines, and brain, which will affect them later on in life. The real focus here is to try to reduce morbidity in preterm babies and give these kids a chance at a healthier life.”
Howell and her team of researchers also found that the risk-standardized morbidity-mortality rate was twice as high for preterm infants born in hospitals in the highest morbidity-mortality tertile versus those born in hospitals with the lowest morbidity-mortality. Pregnancy normally lasts about 40 weeks, and babies born after 37 weeks are considered full term. The study focused on the most vulnerable preterm infants, delivered from 24 to 31 completed weeks’ gestation.
The researchers examined 7,177 very preterm infants from 39 New York City hospitals and found that 28 percent of the babies died or experienced serious complications between the years 2010-2014. Compared to white infants, however, black and Hispanic infants were more likely to die or have severe heath issues.
The study measured the composite of mortality (neonatal or in-hospital up to a year after birth) and severe morbidity. A risk-adjusted neonatal morbidity-mortality rate was generated for very preterm infants in each hospital. Hospitals were ranked using this measure, and differences in the distribution of black, Hispanic, and white very preterm births were assessed among the hospitals.
“This study shines light on the idea that we really need to focus on narrowing disparities when we think about hospital quality improvement,” said Dr. Howell. “Additionally, these disparities are not just local to New York City. We know that there are infant and neonatal racial and ethnic disparities that have been longstanding in this country.”
This study was supported by award R01HD078565 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health.
Also making key research contributions from Mount Sinai were Teresa Janevic, PhD, MPH; Natalia N. Egorova, PhD, MPH; and Amy Balbierz, MPH. Adjunct Mount Sinai Faculty include Paul L. Hebert, PhD and Jennifer Zeitlin, DSc, MA.
About the Mount Sinai Health System
Mount Sinai Health System is one of the nation’s leading integrated academic health systems and one of the largest in the New York metropolitan area. Its comprehensive system includes seven hospitals, more than 400 outpatient practices, over 600 research and clinical laboratories, the Icahn School of Medicine at Mount Sinai, the Graduate School of Biomedical Sciences, and the Mount Sinai Phillips School of Nursing. Together, the Health System comprises approximately 48,000 employees, more than 9,000 physicians, and 8,600 nurses.
As a leading learning health system, Mount Sinai combines clinical expertise with scientific discovery to improve patient care while training the next generation of health care and biomedical leaders. The Health System provides care across every stage of life, from prenatal care through geriatrics, while advancing personalized medicine through artificial intelligence, data science, and biomedical research.
Mount Sinai is consistently recognized among the nation’s leading academic health systems for patient care, research, and education. The Mount Sinai Hospital is ranked No. 1 in New York by Newsweek and No. 5 on the magazine’s World’s Best Hospitals list. The Icahn School of Medicine at Mount Sinai ranks No. 11 among U.S. medical schools and No. 1 among freestanding medical schools for National Institutes of Health funding, reflecting the strength of its scientific enterprise and leadership in biomedical research.
"Pearls From - Elizabeth Howell, MD" - Hazel Shahgholi Smith
May 24, 2018 View All Press Releases