ASSESSING VARIATIONS IN MANAGEMENT OF PREMATURITY

美国黑人婴儿死亡的可能性是白人婴儿的两倍多。在曼哈顿上城，与以白人为主的上东区相比，东哈莱姆区和中央哈莱姆区的少数族裔社区的婴儿死亡率高出四倍。死亡率的这种差异与黑人早产儿的发生率更高有关。极低出生体重儿(1500克)死亡的可能性是正常出生体重儿的90倍，而极低出生体重儿在黑人中的发生率是白人的3.5倍。虽然黑人婴儿比白人更有可能早产，但已有几种干预措施被证明可以降低早产儿的主要发病率和死亡率。这些干预措施使用不足的程度以及少数民族患者与白人患者使用不足的相对程度尚未得到很好的记录。此外，白人和非白人早产儿在纽约市不同医院接受护理的程度尚不清楚。同样，NICU在有效管理早产儿方面是否在实践中有所不同还没有研究。我们建议使用病历回顾来评估三种有效的干预措施(产前皮质类固醇、表面活性物质治疗和维持体温)在早产儿管理中的使用不足。首先，我们将使用出生证明数据来确认和扩展来自医院出院摘要的初步数据，表明黑人早产儿比白人早产儿更有可能在低容量医院出生。我们将衡量两家主要服务于哈莱姆区东部和中部的低流量医院和一家服务于哈莱姆区东部和中部的高流量医院以及一家服务于哈莱姆区东部和中部以及来自纽约市其他地区的多元化人口的高流量医院对选定的有效干预措施使用不足的情况。我们将评估以少数族裔为主的医院与以白人为主的社区的医院之间，以及服务于不同患者群体的一家医院内，使用不足的比率是否因种族和民族而有所不同。最后，我们将调查有效干预措施使用不足的可能原因，这些干预措施优先影响东哈莱姆区和中部哈莱姆区的黑人和拉美裔社区。

Black infants in the U.S. are more than twice as likely to die as white infants. In upper Manhattan, infant mortality rates are four times higher for the minority communities of East and Central Harlem as compared with the predominantly white Upper East Side. This disparity in mortality rates is linked to a greater incidence of prematurity among blacks. Very low birth weight infants (<1500 grams) are 90 times more likely to die than normal birth weight infants, and very low birthweight is 3.5 times more common among blacks than it is among whites. While black infants are much more likely than whites to be born premature, several interventions have been demonstrated to reduce major morbidity and mortality in premature infants. The degree of underuse of these interventions and the relative magnitude of underuse for minority versus white patients has not been well documented. Furthermore, the extent to which white and non-white premature infants receive care at different hospitals in New York City is unknown. Likewise, whether NICUs differ in practice with respect to effective management of prematurity has not been studied. We propose to use medical record review to assess the underuse of three effective interventions (antenatal corticosteroids, surfactant therapy, and maintenance of body temperature) in the management of prematurity. First, we will use birth certificate data to confirm and expand upon preliminary data from hospital discharge abstracts in showing that black premature infants are more likely than white premature infants to be born at low volume hospitals. We will measure underuse of selected effective interventions at two low volume hospitals serving predominantly women from East and Central Harlem and at a high volume hospital serving East and Central Harlem and at a high volume hospital serving East and Central Harlem as well as a diverse population from other areas of New York City. We will assess whether rates of underuse differ by racial and ethnic groups among hospitals serving predominantly minority versus predominantly white communities, and within the one hospital serving a diverse patient population. Finally, we will investigate the likely causes of underuse of effective interventions that preferentially impact the Black and Hispanic communities of East and Central Harlem.