We are all aware of the health disparities for newborns, but those data are largely for infants who are born preterm. What about those infants who are born term and healthy?
Dr. Kimberly Glazer and colleagues at Icahn School of Medicine, the University of Washington, and the University of Pennsylvania analyzed 2010-2014 birth certificate and hospital discharge data from 40 New York City Hospitals for 483,834 term, singleton infants who were born without preexisting fetal medical conditions or low birth weight. Their aim was to better understand if there were racial and ethnic disparities for this low-risk group of infants and, if so, whether hospital quality played a role in the disparities. They report their findings in an article being early released by Pediatrics this week (10.1542/peds.2020-024091).
You may or may not be surprised to learn that, when the authors looked at unexpected newborn complications, there were important disparities. Black and Hispanic infants were 50% and 20%, respectively, more likely to have unexpected newborn complications.
When data from birth hospitals were analyzed, there was a 6-fold difference in newborn complications between hospitals! Black and Hispanic infants were 3 times more likely to be born in hospitals with the highest neonatal morbidity, and 70% of white and 62% of Asian infants were born in hospitals with the lowest neonatal morbidity.
We invited Drs. Djurjati Ravi, Elliott Main, and Jochen Profit from Stanford University to provide a commentary to accompany this important article (10.1542/peds.2021-050768). They note that many families who are disadvantaged do not have the means to access higher-quality hospitals, and that “barriers that prevent racial/ethnic and vulnerable populations from accessing high quality care are a form of institutional racism that perpetuates disadvantage.”
What can we do about these disparities? In their commentary, Drs. Ravi, Main, and Profit emphasize the importance of strengthening the quality improvement capability of these hospitals that predominantly care for vulnerable populations. This could be done through quality improvement collaboratives or partnerships with hospitals that have strong QI programs. They also discuss the need for improved resource allocation and offer suggestions of models that could mitigate these disparities.
You will want to read the thought-provoking article and commentary. I do want to note that this study involved only hospitals in New York City, and so it will be important to conduct similar studies elsewhere, so that we can begin to consider what changes we need to make to mitigate these disparities.