Double Disadvantage in Delivery Hospital for Black and Hispanic Women and High-Risk Infants.

Publisher: Kluwer Academic/Plenum Publishers Country of Publication: United States NLM ID: 9715672 Publication Model: Print Cited Medium: Internet ISSN: 1573-6628 (Electronic) Linking ISSN: 10927875 NLM ISO Abbreviation: Matern Child Health J Subsets: MEDLINE

Publication: 1999- : New York, NY : Kluwer Academic/Plenum Publishers
Original Publication: New York : Plenum Press, c1997-

Infant Mortality*; Healthcare Disparities/*statistics & numerical data ; Maternal Health/*statistics & numerical data ; Quality of Health Care/*statistics & numerical data; Adult ; Black or African American/statistics & numerical data ; Female ; Hispanic or Latino/statistics & numerical data ; Hospitals ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/epidemiology ; Middle Aged ; Morbidity ; New York City/epidemiology ; Pregnancy ; White People/statistics & numerical data ; Young Adult

Objective: To determine whether delivery hospitals that perform poorly for women also perform poorly for high-risk infants and to what extent Black and Hispanic women receive care at hospitals that perform poorly for both women and infants.
Methods: We examined the correlation between hospital rankings for severe maternal morbidity and very preterm morbidity and mortality in New York City Hospitals using linked birth certificate and state discharge data for 2010-2014. We used mixed-effects logistic regression with a random hospital-specific intercept to generate risk standardized severe maternal morbidity rates and very preterm birth neonatal morbidity and mortality rates for each hospital. We ranked hospitals separately by these risk-standardized rates. We used k-means cluster analysis to categorize hospitals based on their performance on both metrics and risk-adjusted multinomial logistic regression to estimate adjusted probabilities of delivering in each hospital-quality cluster by race/ethnicity.
Results: Hospital rankings for severe maternal morbidity and very preterm neonatal morbidity-mortality were moderately correlated (r = .32; p = .05). A 5-cluster solution best fit the data and yielded the categories for hospital performance for women and infants: excellent, good, fair, fair to poor, poor. Black and Hispanic versus White women were less likely to deliver in an excellent quality cluster (adjusted percent of 11%, 18% vs 28%, respectively, p < .001) and more likely to deliver in a poor quality cluster (adjusted percent of 28%, 20%, vs. 4%, respectively, p < .001).
Conclusions for Practise: Hospital performance for maternal and high-risk infant outcomes is only moderately correlated but Black and Hispanic women deliver at hospitals with worse outcomes for both women and very preterm infants.

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R01 HD078565 United States HD NICHD NIH HHS; R01 MD007651 United States MD NIMHD NIH HHS; R01MD007651 United States MD NIMHD NIH HHS; R01HD078565 United States HD NICHD NIH HHS

Keywords: Disparities; Hospital; Maternal and child health; Quality; Very preterm

Date Created: 20200419 Date Completed: 20210114 Latest Revision: 20240821

20240821

PMC7265984

10.1007/s10995-020-02911-9

32303940