Black and Hispanic preterm infants in New York were more likely to be born in poor quality-of-care facilities, which contributed to higher morbidity and mortality rates among these populations, according to a new study.
Neonatal intensive-care units across New York have wide variations in quality of care, according to the study published Tuesday in JAMA Pediatrics, and that variation can affect patient outcomes.
At the worst of the 39 New York hospitals studied for the period of 2010-2014, infants died or developed chronic diseases at a rate eight times higher than the best hospitals; 43.4% of black and 34.4% of Hispanic preterm infants were born in the hospitals with the highest rates of neonatal morbidity and mortality. Just 22.9% of white preterm babies were born in those hospitals.
"To me, the big take-home message is there is still wide variation in NICU performance," said Dr. Elizabeth Howell, an author of the study and professor of population health science and policy at Mount Sinai Health System in New York.
For the last 10 years or so, hospitals have worked hard to improve quality of care in NICUs with much success, so Howell said she was surprised to see that such a wide variation in care still persists. Even though the study focuses on New York, the city represents roughly 5% of overall U.S. births and has a diverse hospital and patient demographic.
Additionally, black and Hispanic preterm babies had higher rates of morbid conditions. About 32% of black preterm babies and 28% of Hispanic preterm babies died or had a morbidity like bronchopulmonary dysplasia, a chronic lung disease. By comparison, 22.5% of white preterm babies died or had a morbidity.
The study doesn't show exactly what caused the differences in outcomes amongst NICUs in New York, but Howell said she's interested in researching the factors at play. An array of circumstances could be to blame, such as the safety culture or practices at the institution.
Howell said it's also hard to know why black or Hispanic mothers are more likely to give birth at these lower-quality care facilities. People choose where they give birth based on different factors like location, physician referral or access.
"Given the significant improvements in neonatal care over the past decade, it is time to direct these quality efforts to reduce racial and ethnic disparities in neonatal outcomes," the authors wrote.
