Racial and Economic Neighborhood Segregation, Site of Delivery, and Morbidity and Mortality in Neonates Born Very Preterm
| Autor: | Jennifer Zeitlin, Amy Balbierz, Anne Marie Stroustrup, Natalia N. Egorova, Paul L. Hebert, Elizabeth A. Howell, Teresa Janevic |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Hospital quality Psychological intervention MEDLINE Infant Newborn Diseases Article Cohort Studies 03 medical and health sciences 0302 clinical medicine Pregnancy Residence Characteristics 030225 pediatrics Infant Mortality Humans Medicine Very Preterm Birth 030212 general & internal medicine Retrospective Studies Neonatal mortality business.industry Infant Newborn Infant Retrospective cohort study Hospitals Black or African American Very preterm Pediatrics Perinatology and Child Health Premature Birth Female New York City Neighborhood context business Infant Premature Demography |
| Zdroj: | J Pediatr |
| ISSN: | 0022-3476 |
| DOI: | 10.1016/j.jpeds.2021.03.049 |
| Popis: | To assess the influence of racial and economic residential segregation of home or hospital neighborhood on very preterm birth morbidity and mortality in neonates born very preterm.We constructed a retrospective cohort of n = 6461 infants born32 weeks using 2010-2014 New York City vital statistics-hospital data. We calculated racial and economic Index of Concentration at the Extremes for home and hospital neighborhoods. Neonatal mortality and morbidity was defined as death and/or severe neonatal morbidity. We estimated relative risks for Index of Concentration at the Extremes measures and neonatal mortality and morbidity using log binomial regression and the risk-adjusted contribution of delivery hospital using Fairlie decomposition.Infants whose mothers live in neighborhoods with the greatest relative concentration of Black residents had a 1.6 times greater risk of neonatal mortality and morbidity than those with the greatest relative concentration of White residents (95% CI 1.2-2.1). Delivery hospital explained more than one-half of neighborhood differences. Infants with both home and hospital in high-concentration Black neighborhoods had a 38% adjusted risk of neonatal mortality and morbidity compared with 25% of those with both home and hospital high-concentration White neighborhoods (P = .045).Structural racism influences very preterm birth neonatal mortality and morbidity through both the home and hospital neighborhood. Quality improvement interventions should incorporate a framework that includes neighborhood context. |
| Databáze: | OpenAIRE |
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