The Contribution of Geography to Black/White Differences in the Use of Low Neonatal Mortality Hospitals in New York City
The Contribution of Geography to Black/White Differences in the Use of Low Neonatal Mortality Hospitals in New York City
复制标题
DOI：
10.1097/mlr.0b013e3182019144
复制
发表时间：
2011-02-01
期刊：
影响因子：
3
通讯作者：
Howell, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Hebert, Paul L.;Chassin, Mark R.;Howell, Elizabeth A.
背景资料：在使用高质量医院护理方面的种族差异导致极低出生体重（VLBW）新生儿死亡率的种族差异。目的：我们探讨了医院的地理分布在纽约市极低出生体重新生儿母亲使用顶级医院的种族差异中所起的作用。研究设计：回顾性分析生命统计和行政数据库。主题：1996年至2001年纽约市对非西班牙裔黑人的极低出生体重分娩（n = 4947）和非西班牙裔白色人结果：黑人母亲在顶级医院分娩的可能性较低（白色= 44%，黑人= 28%; P < 0.001），顶级医院不太可能位于黑人母亲的社区（白色= 40%，黑人= 33%; P < 0.001）。然而，距离并没有造成顶级医院使用率的差异。与非西班牙裔白色母亲相比，非西班牙裔黑人母亲住得离顶级医院稍近（近0.65英里; P < 0.001），两个种族的母亲经常绕过他们附近的医院（黑人= 62%绕过，白色= 71%; P < 0.001）。不注意推荐的产前行为与使用较近的医院有关，这表明地理上的接近对脆弱新生儿的母亲来说是最重要的。医院质量的措施，如新生儿重症监护病房的水平和容量更强烈地与使用医院的白色母亲比黑人mother.Conclusions：使用顶级医院的VLBW新生儿的母亲的地理位置的影响是复杂的。除了距离或地理位置之外，其他个人和医院的特征也影响了纽约市的医院使用情况。
Background: Racial differences in the use of high-quality hospital care contribute to racial disparities in mortality for very low birth weight (VLBW) neonates.Objectives: We explored the role that geographic distribution of hospitals plays in the racial disparity in the use of top-tier hospitals by mothers of VLBW neonates in New York City.Research Design: Retrospective analysis of Vital Statistics and administrative databases.Subjects: VLBW deliveries in New York City from 1996 to 2001 to non-Hispanic Black (n = 4947) and non-Hispanic White (n = 1615) mothers.Results: Black mothers were less likely to deliver in a top-tier hospitals (White = 44%, Black = 28%; P < 0.001) and top-tier hospitals were less likely to be located in Black mothers' neighborhoods (White = 40%, Black = 33%; P < 0.001). Distance, however, did not contribute to the disparity in use of top-tier hospitals. Non-Hispanic Black mothers lived marginally closer to a top-tier hospital than non-Hispanic White mothers (0.65 miles closer; P < 0.001), and mothers of both the races often bypassed their neighborhood hospital (Black = 62% bypassed, White = 71%; P < 0.001). Inattention to recommended prenatal behaviors was associated with using a closer hospital, suggesting that geographic proximity was most important to mothers of vulnerable neonates. Purported measures of hospital quality such as Neonatal Intensive Care Unit level and volume were more strongly associated with use of hospital for White mothers than for Black mothers.Conclusions: The influence of geography on the use of top-tier hospitals for mothers of VLBW neonates is complex. Other personal and hospital characteristics, not just distance or geography, also influenced hospital use in New York City.