Racial and Ethnic Differences Over Time in Outcomes of Infants Born Less Than 30 Weeks' Gestation
Racial and Ethnic Differences Over Time in Outcomes of Infants Born Less Than 30 Weeks' Gestation
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DOI：
10.1542/peds.2019-1106
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发表时间：
2019-09-01
期刊：
影响因子：
8
通讯作者：
Horbar, Jeffrey D.
中科院分区：
文献类型：
--
作者：
Boghossian, Nansi S.;Geraci, Marco;Horbar, Jeffrey D.
目的：通过种族和民族研究随着时间的推移护理实践的变化，以及医院死亡率和严重发病率的降低是否使少数民族的婴儿受益于白色母亲的婴儿。方法：研究了2006年1月至2017年12月在美国佛蒙特州牛津网络中心出生的22至29周妊娠的婴儿。我们按出生年份检查了非裔美国人和西班牙裔婴儿与白色婴儿的死亡率和发病率差异以及95%置信区间。我们测试的时间差异，死亡率和发病率之间的白色和非洲裔美国人或西班牙裔婴儿使用似然比检验嵌套二项式regression models.Results：差异为某些护理措施，如产前皮质类固醇和一些住院的结果缩小了随着时间的推移，少数民族婴儿。与白色婴儿相比，非裔美国婴儿的死亡率、体温过低、坏死性小肠结肠炎和迟发性脓毒症下降更快，而西班牙裔婴儿的死亡率、呼吸窘迫综合征和气胸下降更快。随着时间的推移，非裔美国人和西班牙裔婴儿与白色婴儿之间的其他发病率差异恒定。尽管有所改善，结果，包括体温过低，死亡率，坏死性小肠结肠炎，迟发性败血症，严重的脑室内出血仍然升高的研究期结束时，特别是在非洲裔美国人infants.CONCLUSIONS：种族和民族的差异，在重要的护理实践和某些结果有所减少。少数民族婴儿的质量赤字发生了几个护理实践措施和潜在的可修改的结果表明，为少数民族服务的医院量身定制的质量改进举措的关键作用。
OBJECTIVES:To examine changes in care practices over time by race and ethnicity and whether the decrease in hospital mortality and severe morbidities has benefited infants of minority over infants of white mothers.METHODS:Infants 22 to 29 weeks' gestation born between January 2006 and December 2017 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals for African American and Hispanic versus white infants by birth year. We tested temporal differences in mortality and morbidity rates between white and African American or Hispanic infants using a likelihood ratio test on nested binomial regression models.RESULTS:Disparities for certain care practices such as antenatal corticosteroids and for some in-hospital outcomes have narrowed over time for minority infants. Compared with white infants, African American infants had a faster decline for mortality, hypothermia, necrotizing enterocolitis, and late-onset sepsis, whereas Hispanic infants had a faster decline for mortality, respiratory distress syndrome, and pneumothorax. Other morbidities showed a constant rate difference between African American and Hispanic versus white infants over time. Despite the improvements, outcomes including hypothermia, mortality, necrotizing enterocolitis, late-onset sepsis, and severe intraventricular hemorrhage remained elevated by the end of the study period, especially among African American infants.CONCLUSIONS:Racial and ethnic disparities in vital care practices and certain outcomes have decreased. That the quality deficit among minority infants occurred for several care practice measures and potentially modifiable outcomes suggests a critical role for quality improvement initiatives tailored for minority-serving hospitals.