Addressing racial & ethnic differences in infant mortality

在过去的二十年里，美国的婴儿死亡率急剧下降，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，但仍然存在着巨大的种族差异，特别是在黑人和白人婴儿之间。黑人婴儿死亡率是白人婴儿死亡率的2.4倍。这种巨大的种族差异是一项重大的公共政策关切，并导致总统将婴儿死亡率确定为六个目标领域之一，以减少美国在保健方面的种族差异。在这个项目中，我们重点关注高危婴儿在获得护理方面的种族和民族差异。具体而言，我们将解决以下问题：在获得高质量和高水平的新生儿重症监护病房服务方面，种族和民族差异的程度如何？哪些因素是可变的，因此可以通过政策干预来减少美国婴儿死亡率的种族差距？该项目将使用1999-2000年期间加利福尼亚州所有出生的出生、记录、死亡记录和出院摘要数据。近年来，新生儿重症监护病房的提供发生了很大的变化，从高水平新生儿重症监护病房的区域化服务转变为越来越多的低水平新生儿重症监护病房提供护理，患者护理质量的后果在很大程度上是未知的。加州一直走在医疗服务提供者转变的前沿，也走在通过管理式医疗计划接收医疗保险覆盖范围的巨大转变的前沿。该州是一个种族多元化的州，拉美裔和亚裔人口数量最多，黑人人口数量排名第五，因此为研究拟议中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.