Disparate black and white neonatal mortality rates among infants of normal birth weight in Chicago: a population study

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

IMPORTANCE

Racial/ethnic disparities in quality of care among extremely preterm infants are associated with adverse outcomes.

OBJECTIVE

To assess whether racial/ethnic disparities in major outcomes and key care practices were changing over time among extremely preterm infants.

DESIGN, SETTING, AND PARTICIPANTS

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.

MAIN OUTCOMES AND MEASURES

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.

RESULTS

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.

CONCLUSIONS AND RELEVANCE

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.

Social disadvantage as a risk for first pregnancy among adolescent females in the United States

PURPOSE

Differences in underlying determinants of pregnancy at different stages of adolescent development have implications for prevention strategies. We sought to determine whether social disparities in rates of adolescent pregnancy vary between early, middle, and late adolescence. We hypothesized that as age increases, racial and socioeconomic disparities in rates of teen conception decrease.

METHODS

Data were obtained from the National Survey of Family Growth cycle 6. Outcome variables indicated whether respondents had a first pregnancy at ages <15 years, 15-17 years, or 18-19 years. Independent variables were race and maternal education level. Logistic regression was used to calculate the relative odds of first conception in a given age range by race and maternal education level.

RESULTS

The disparity in odds of pregnancy between black and white teens is maximal in early adolescence (odds ratios <15 years: 3.9) and decreased by nearly 50% in late adolescence (odds ratios 18-19 years: 2.0, p < .01). After stratifying by maternal education level, the same trends are seen.

CONCLUSIONS

In accordance with our hypothesis, we found that social disparities in pregnancy rates decrease between early and late adolescence. Although pregnancy prevention efforts often target those at social risk including poor minority youth, fewer acknowledge and target the risks associated with development of sexuality in all teens. Efforts to better define the nature of healthy adolescent sexual development may lead to pregnancy prevention interventions focused on developmental risk that can apply to a wider set of adolescents.

Economic distress and cause-of-death patterns for black and non-black men in Chicago: reconsidering the relevance of classic epidemiological transition theory

The mortality disadvantage of African Americans is well documented, but previous studies have not considered its implications for population theory in the general case of industrialized nation states with high levels of income inequality. This paper examines the relevance of classic epidemiological theory to the extremes of income and mortality observed in Chicago, one of America's most racially divided cities. We analyze cause-specific death rates for black and non-black male populations residing in Chicago's community areas by using linked data from the 1990 Census and from 1989-1991 individual death certificates. The same cause-of-death patterns explain much of the mortality of black and non-black men. These two major structures include one, degenerative diseases, the other, "tough-living" causes (accidents, homicides, and liver disease). Community socioeconomic status is strongly related to tough-living deaths within each racial group, and to degenerative deaths for African Americans. Black men's tough-living mortality is much greater than non-blacks', but their younger age structure suppresses their degenerative death rates. Aggregate unemployment and social disorganization account for the most salient disparities in mortality across racial groups. This patterning of mortality along a socioeconomic continuum supports epidemiological theory and extends its applicability to highly unequal populations within industrialized countries.

The anatomy of a disparity in infant mortality

This article suggests that while disparities in infant mortality have been longstanding, the mechanisms of disparity creation are undergoing intense change. This dynamic character is explored by first developing an analytic model that examines the interaction between social factors and the public health and clinical capacity to intervene. Disparities in infant mortality are then broken down into their component parts and linked to specific arenas of intervention. Disparities in postneonatal mortality are being shaped by differential access to interventions designed to prevent infant death from congenital anomalies and the Sudden Infant Death Syndrome. Disparities in neonatal mortality are primarily determined by factors that influence the birthrate of extremely premature infants and access to specialized obstetrical and pediatric care. This analysis suggests that the epidemiology and social meaning of disparities in infant mortality are intensely dynamic and increasingly reflect the interaction between social forces and technical innovation.

Infant mortality, class, race and gender: implications for the health profession

The disparity in white and African American infant mortality has not only persisted but increased over time and is not expected to diminish in the near future. This article reviews the theoretical and empirical literature on the constellation of class, race, and gender vulnerabilities on African American life as manifested in infant mortality. Utilizing a public health framework, it provides an overview of primary, secondary, and tertiary prevention initiatives within the social work practice domain. Ethnic-sensitive practice perspective for social workers is highlighted and includes empowerment, strengths, Africentric, and advocacy and social action.

An investigation into the disparity between Australian aboriginal and Caucasian perinatal mortality rates

The babies of Australian Aboriginal mothers have higher overall perinatal mortality rates than the babies of Caucasian mothers. They are also more likely to be preterm and of low birth weight. This study used Poisson regression models to adjust the perinatal mortality rates for differences in the gestational age and birth weight distributions of Aborigines and Caucasians. The intriguing finding was that full-term Aboriginal neonates (the group at lowest absolute risk) fare particularly poorly in comparison with Caucasian (adjusted relative risk: 2.9; 95% confidence interval; 1.5 to 5.5). Possible explanations for this phenomenon are explored.

Neonatal technology, perinatal survival, social consequences, and the perinatal paradox

Exogenous surfactant therapy for premature infants with respiratory distress syndrome has had a significant impact on infant mortality and on some complications of prematurity. Yet the total number of low-birthweight infants has not declined, resulting in a high-risk population who would require surfactant therapy and long-term child care. Surviving low-birthweight infants (despite surfactant therapy) remain at risk for the consequences of premature birth, such as neurosensory impairment, cerebral palsy, and chronic lung disease. In addition, because of the close association between poverty and low birthweight, surviving premature infants are at increased risk for the new morbidities such as violence, homelessness, child abuse and neglect, and addictive drug use. A goal should be to reduce the risk of being born with a low birthweight, rather than having to treat the consequences of premature gestation. Despite the marvelous advances that permit us to treat respiratory distress syndrome, the continuing high low-birthweight rate places a significant strain on our health care system. The goal should be redirected to identifying large population-based efforts to reduce the number of low-birthweight infants.