Mortality among very low-birthweight infants higher at minority-serving hospitals

BACKGROUND: Neonatal mortality rates--that is, mortality in the first 28 days--in the United States fell significantly between 1940 and 2000 from 28.8 deaths per live birth to 4.6 deaths. Yet ethnic and racial disparities have persisted or increased during that time. Deaths among very low-birthweight infants (VLBW) account for more than half the infant deaths in the United States. The researchers sought to determine whether there is a correlation between mortality among VLBW infants and quality of care. The research was based on data from 74,000 infants at 332 hospitals across the nation.

FINDINGS: The researchers found that infant mortality for black and white infants born at minority-serving hospitals, defined as hospitals where 35 percent of VLBW infants are black, was significantly higher than for black and white infants born at hospitals where fewer than 15 percent of these infants are black. These findings suggest that minority-serving hospitals provide lower quality care to VLBW infants than do other hospitals.

IMPACT: "There's a known disparity between blacks and whites in infant mortality," said Dr. Leo Morales, associate professor of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, and the lead researcher. "This study points to a possible explanation for that disparity--namely that hospitals where the majority of black infants are born do not provide the same quality of care as hospitals where the majority of White infants are born." The next step is to investigate the reasons for the disparity, such as financial status, physician and nursing staffing and other hospital characteristics.

AUTHORS: Other researchers on this study in addition to Morales are Douglas Staiger of Dartmouth College and the National Bureau of Economic Research; Jeffrey D. Horbar of the University of Vermont and the Vermont Oxford Network; Joseph Carpenter, Vermont Oxford Network; Michael Kenny of the University of Vermont; Jeffrey Geppert, National Bureau of Economic Research, and Jeannette Rogowski, RAND Corp.

JOURNAL: "Mortality Among Very Low-Birthweight Infants in Hospitals Serving Minority Populations," is published in the December issue of the American Journal of Public Health.

FUNDERS: The Minority Investigator Supplement from the Agency for Healthcare Research and Quality, the UCLA/Drew/RAND Excellence Center to Eliminate Ethnic/Racial Disparities, the UCLA Center for Health Improvement in Minority Elders, the UCLA/Drew Center of Excellence in Partnerships for Community Outreach, and a Robert Wood Johnson Foundation Harold Amos Fellowship Award.

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