Addressing racial & ethnic differences in infant mortality

美国的婴儿死亡率在过去20年里急剧下降，自1980年以来下降了40%。尽管在婴儿存活率方面取得了这些巨大的进步，但仍然存在巨大的种族差距，特别是在黑人和白人婴儿之间。黑人的婴儿死亡率是白人的2.4倍。这一巨大的种族差距是一个重大的公共政策问题，导致总统将婴儿死亡率确定为减少美国健康方面的种族差距的六个目标领域之一。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。具体来说，我们将解决以下问题：在获得高质量和高水平的NICU服务方面，种族和族裔差异有多大？哪些因素是可变的，因此可以通过政策干预来缩小美国婴儿死亡率的种族差距？该项目将使用1999-2000年加利福尼亚州所有出生人口的相关出生、记录、死亡记录和医院出院摘要数据。近年来，NICU护理的提供发生了很大变化，从高级别NICU的服务区域化转向越来越多的低级别NICU提供护理，患者护理质量的后果基本上是未知的。加州一直处于这一提供者转变的前沿，也是通过管理式医疗计划获得医疗保险覆盖范围的重大转变。该州的种族多元化，拉美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.