Disparities in delivery hospital risk-adjusted outcomes for very low birthweight infants: the role of NICU volume and level of care.

IF 2.4 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Journal of Perinatology Pub Date : 2025-09-27 DOI:10.1038/s41372-025-02434-7

Gia Yannekis, Sarah N Kunz, Molly Passarella, Brielle Formanowski, Scott A Lorch

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引用次数: 0

Abstract

Objective: Describe racial and ethnic differences in delivery hospital NICU risk-adjusted mortality and morbidity rates (RAMMR), stratified by volume and level of care.

Study design: Cross-sectional analysis of all very low birthweight (<1500 g; VLBW) infants born in Michigan, Oregon, and South Carolina between 2010 and 2020 and Pennsylvania between 2010 and 2018 (n = 37,784). Lorenz concentration curves and indices were used to describe differences in NICU RAMMR by race and ethnicity. Analysis was performed for overall cohort; high-level, high-volume NICUs; and low-level and/or low-volume NICUs.

Result: Despite being most frequently born at high-level, high-volume centers, Non-Hispanic Black (NHB) neonates were overrepresented at hospitals with high RAMMR and all other groups were overrepresented at hospitals with lower RAMMR. Differences were most pronounced in the low-level and/or low-volume cohort.

Conclusion: NHB VLBW infants born at hospitals with low-level and/or low-volume NICUs are disproportionately exposed to adverse outcomes and must be the focus of future policy interventions.

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极低出生体重儿的分娩医院风险调整结果差异：新生儿重症监护室容量和护理水平的作用

目的：描述分娩医院NICU风险调整死亡率和发病率（RAMMR）的种族和民族差异，按容量和护理水平分层。研究设计：所有极低出生体重的横断面分析(结果：尽管非西班牙裔黑人（NHB）新生儿最常出生在高水平、高容量的中心，但在RAMMR高的医院中，非西班牙裔黑人（NHB）新生儿的比例过高，而在RAMMR较低的医院中，所有其他群体的比例过高。差异在低水平和/或低容量队列中最为明显。结论：在低容量和/或低容量nicu医院出生的NHB VLBW婴儿暴露于不良后果的比例过高，必须成为未来政策干预的重点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Perinatology 医学-妇产科学

CiteScore

5.40

自引率

6.90%

发文量

284

审稿时长

3-8 weeks

期刊介绍： The Journal of Perinatology provides members of the perinatal/neonatal healthcare team with original information pertinent to improving maternal/fetal and neonatal care. We publish peer-reviewed clinical research articles, state-of-the art reviews, comments, quality improvement reports, and letters to the editor. Articles published in the Journal of Perinatology embrace the full scope of the specialty, including clinical, professional, political, administrative and educational aspects. The Journal also explores legal and ethical issues, neonatal technology and product development. The Journal’s audience includes all those that participate in perinatal/neonatal care, including, but not limited to neonatologists, perinatologists, perinatal epidemiologists, pediatricians and pediatric subspecialists, surgeons, neonatal and perinatal nurses, respiratory therapists, pharmacists, social workers, dieticians, speech and hearing experts, other allied health professionals, as well as subspecialists who participate in patient care including radiologists, laboratory medicine and pathologists.