Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants
Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants
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DOI：
10.1001/jamapediatrics.2019.0241
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发表时间：
2019-05-01
期刊：
影响因子：
26.1
通讯作者：
Firebaugh, Glenn
中科院分区：
文献类型：
--
作者：
Horbar, Jeffrey D.;Edwards, Erika M.;Firebaugh, Glenn
在美国，种族和少数民族获得的医疗保健质量低于非西班牙裔的白色人。少数民族婴儿接受护理和护理质量中可能发挥的作用尚不清楚。目的：确定美国新生儿重症监护病房（NICU）中极低出生体重和极早产儿护理的隔离和不平等程度。这项在佛蒙特州牛津网络中对743名NICU进行的队列研究包括117982名黑人、西班牙裔、亚洲人和白色婴儿，出生时体重为401 g至150 0 g或妊娠22至29周，从2014年1月至2016年12月。分析开始于2018年1月。主要结果和指标在医院层面计算NICU隔离指数和NICU不平等指数，作为与黑人、西班牙裔和亚裔婴儿与白色婴儿相比的洛伦兹曲线相关的基尼系数，根据NICU隔离指数的白色婴儿比例和复合婴儿监护仪对NICU进行排名新生儿重症监护室不平等指数（新生儿重症监护结局研究指标）评分。在743个NICU中，36359名黑人[31%]、21808名西班牙裔[18%]、5920名亚洲人[5%]和53895名白色人[46%]按种族和民族隔离（NICU隔离指数：黑人：0.50 [95% CI，0.46-0.53]，西班牙裔：0.58 [95% CI，0.54-0.61]，亚裔：0.45 [95% CI，0.40-0.50]）。与白色婴儿相比，黑人婴儿集中在NICU，质量评分较低，西班牙裔和亚裔婴儿集中在NICU，质量评分较高（NICU不平等指数：黑人：0.07 [95% CI，0.02-0.13]，西班牙裔：-0.10 [95% CI，-0.17至-0.04]，亚裔：-0.26 [95% CI，-0.32至-0.19]）。有显着的变化，人口普查地区之间的加权平均新生儿重症监护室质量评分（范围：-0.69至0.85）。居住区解释了观察到的不平等，西班牙裔婴儿，但不是黑人或亚洲infants.CONCLUSIONS AND RELEVANCE黑人，西班牙裔和亚洲婴儿被隔离在NICU，反映了种族隔离的少数民族人口在美国。NICU质量在地理区域之间存在很大差异。考虑到这些差异后，与白色婴儿相比，亚裔婴儿在高质量的NICU接受护理，而黑人婴儿在低质量的NICU接受护理。解释这些模式需要了解社会人口因素和公共政策对少数民族妇女及其婴儿的医院质量、可及性和选择的影响。
IMPORTANCE Racial and ethnic minorities receive lower-quality health care than white non-Hispanic individuals in the United States. Where minority infants receive care and the role that may play in the quality of care received is unclear.OBJECTIVE To determine the extent of segregation and inequality of care of very low-birth-weight and very preterm infants across neonatal intensive care units (NICUs) in the United States.DESIGN, SETTING. AND PARTICIPANTS This cohort study of 743 NICUs in the Vermont Oxford Network included 117 982 black, Hispanic, Asian, and white infants born at 401 g to 150 0 g or 22 to 29 weeks' gestation from January 2014 to December 2016. Analysis began January 2018.MAIN OUTCOMES AND MEASURES The NICU segregation index and NICU inequality index were calculated at the hospital level as the Gini coefficients associated with the Lorenz curves for black, Hispanic, and Asian infants compared with white infants, with NICUs ranked by proportion of white infants for the NICU segregation index and by composite Baby-MONITOR (Measure of Neonatal Intensive Care Outcomes Research) score for the NICU inequality index.RESULTS Infants (36 359 black [31%], 218 08 Hispanic [18%], 5920 Asian [5%], and 53 895 white [46%]) were segregated among the 743 NICUs by race and ethnicity (NICU segregation index: black: 0.50 [95% CI, 0.46-0.53], Hispanic: 0.58 [95% CI, 0.54-0.61], and Asian: 0.45 [95% CI, 0.40-0.50]). Compared with white infants, black infants were concentrated at NICUs with lower-quality scores, and Hispanic and Asian infants were concentrated at NICUs with higher-quality scores (NICU inequality index: black: 0.07 [95% CI, 0.02-0.13], Hispanic: -0.10 [95% CI, -0.17 to -0.04], and Asian:-0.26 [95% Cl, -0.32 to -0.19]). There was marked variation among the census regions in weighted mean NICU quality scores (range: - 0.69 to 0.85). Region of residence explained the observed inequality for Hispanic infants but not for black or Asian infants.CONCLUSIONS AND RELEVANCE Black, Hispanic, and Asian infants were segregated across NICUs, reflecting the racial segregation of minority populations in the United States. There were large differences between geographic regions in NICU quality. After accounting for these differences, compared with white infants, Asian infants received care at higher-quality NICUs and black infants, at lower-quality NICUs. Explainingthese patterns will require understanding the effects of sociodemographic factors and public policies on hospital quality, access, and choice for minority women and their infants.