Addressing racial & ethnic differences in infant mortality

美国的婴儿死亡率在过去20年中大幅下降，自1980年以来下降了40%。尽管在婴儿存活率方面取得了巨大的进步，但仍存在很大的种族差异，特别是在黑人和白色婴儿之间。黑人婴儿死亡率是白色的2.4倍。这一巨大的种族差异是一个主要的公共政策问题，并导致总统将婴儿死亡率确定为六个目标领域之一，以减少美国健康方面的种族差异。在这个项目中，我们关注的是高危婴儿在获得护理方面的种族和民族差异。具体而言，我们将讨论以下问题： 在获得保健服务方面， 高质量、高水平的新生儿重症监护服务？ 哪些因素是可变的，因而服从于政策 可以减少婴儿死亡率种族差距的干预措施， 美国？该项目将使用1999-2000年加州所有出生的关联出生、记录、死亡记录和出院摘要数据。近年来，新生儿重症监护室护理的提供发生了很大的变化，从高水平新生儿重症监护室的服务区域化转向在越来越多的低水平新生儿重症监护室提供护理，患者护理质量的后果在很大程度上是未知的。加州一直处于这种提供者转变的最前沿，以及通过管理式医疗计划接收医疗保险覆盖的大转变。该州种族多样，西班牙裔和亚裔出生人数最多，黑人出生人数排名第五，因此为研究拟议的关系提供了肥沃的土壤。

The infant mortality rate in the United States has undergone dramatic decreases in the past two decades, declining by 40% since 1980. Despite these tremendous gains in infant survival, large racial disparities exist, particularly between black and white infants. The black infant mortality rate is 2.4 times as high as that of white. This large racial disparity is a major public policy concern and has led the President to identify infant mortality as one of six areas to be targeted i order to reduce racial disparities in health in the United States. In this project, we focus on racial and ethnic differences in access to care among high-risk infants. Specifically, we will address the following questions: What is the extent of racial and ethnic differences in access to high quality and high-level NICU services? Which factors are mutable and thus amenable to policy interventions that could reduce the racial gap in infant mortality in the United States? The project will use linked birth, records, death records and hospital discharge abstract data for all births in the state of California for the years 1999-2000. The provision of NICU care has undergone large changes in recent years, with a shift away from the regionalization of services in high-level NICUs to the provision of care in an ever-increasing number of lower-level NICUs, with largely unknown consequences of the quality of patient care. California has been at the forefront of this provider shift, as well as to the large shift in the receipt of health insurance coverage through managed care plans. The state is ethnically diverse, with the largest number of Hispanic and Asian births and ranking fifth in the number of black births, thus providing a fertile ground for studying the proposed relationships.