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Black women's choice of hospital to give birth contributes to racial disparities in neonatal deaths

Black infants in the United States are more than twice as likely to die than white infants during the first month of life (the neonatal period). This is partly due to more preterm births among black women. However, the hospitals in which black women deliver also contribute substantially to the black/white disparities in neonatal deaths among infants weighing less than 3.3 pounds, finds a new study.

A team from Mount Sinai School of Medicine analyzed New York City records on all live births and deaths of infants weighing 1.1 to 3.3 lbs (very low birthweight, VLBW), who were born in 45 of the city's hospitals in the 6-year period from 1996 through 2001. The neonatal mortality rates for VLBW infants ranged from 9.6 to 27.2 deaths per 1,000 births, after adjusting for their risk of dying (based on their clinical status). VLBW white infants were more likely to be born in hospitals in the lowest third of neonatal mortality rates (49 percent) compared with VLBW black infants (29 percent).

If black women delivered in the same hospitals as white women, the VLBW black neonatal morality rates would be reduced by 6.7 deaths per 1,000 VLBW births, removing more than one-third (34.5 percent) of the black/white disparity in VLBW neonatal mortality rates in New York City. The hospital volume of VLBW deliveries was modestly associated with VLBW mortality rates, but explained little of the racial disparity. It is not known why hospitals that treat a greater proportion of black VLBW infants experience higher risk-adjusted neonatal mortality rates, but the findings suggest more study is needed in this area.

The reasons why women deliver at specific hospitals likely involve several factors, ranging from where a patient resides and distance to the hospital (which may be influenced by patterns of racial segregation) to physician referral, patient choice, and insurance contracts. The study was supported in part by the Agency for Healthcare Research and Quality (HS10859).

See "Black/white differences in very low birth weight neonatal mortality rates among New York City hospitals," by Elizabeth A. Howell, M.D., M.P.P., Paul Hebert, Ph.D., Samprit Chatterjee, Ph.D., and others, in the March 2008 Pediatrics 121(3), pp. e407-e415.

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