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Objective <p>Describe racial and ethnic differences in delivery hospital NICU risk-adjusted mortality and morbidity rates (RAMMR), stratified by volume and level of care.</p> Study design <p>Cross-sectional analysis of all very low birthweight (&lt;1500 g; VLBW) infants born in Michigan, Oregon, and South Carolina between 2010 and 2020 and Pennsylvania between 2010 and 2018 (<i>n </i>= 37,784). Lorenz concentration curves and indices were used to describe differences in NICU RAMMR by race and ethnicity. Analysis was performed for overall cohort; high-level, high-volume NICUs; and low-level and/or low-volume NICUs.</p> Result <p>Despite being most frequently born at high-level, high-volume centers, Non-Hispanic Black (NHB) neonates were overrepresented at hospitals with high RAMMR and all other groups were overrepresented at hospitals with lower RAMMR. Differences were most pronounced in the low-level and/or low-volume cohort.</p> Conclusion <p>NHB VLBW infants born at hospitals with low-level and/or low-volume NICUs are disproportionately exposed to adverse outcomes and must be the focus of future policy interventions.</p>

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Disparities in delivery hospital risk-adjusted outcomes for very low birthweight infants: the role of NICU volume and level of care

  • 期刊论文

  • 发表日期：

    2025年9月27日

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  • Gia Yannekis,
  • Sarah N. Kunz,
  • Molly Passarella,
  • Brielle Formanowski,
  • Scott A. Lorch

摘要

Objective

Describe racial and ethnic differences in delivery hospital NICU risk-adjusted mortality and morbidity rates (RAMMR), stratified by volume and level of care.

Study design

Cross-sectional analysis of all very low birthweight (<1500 g; VLBW) infants born in Michigan, Oregon, and South Carolina between 2010 and 2020 and Pennsylvania between 2010 and 2018 (n = 37,784). Lorenz concentration curves and indices were used to describe differences in NICU RAMMR by race and ethnicity. Analysis was performed for overall cohort; high-level, high-volume NICUs; and low-level and/or low-volume NICUs.

Result

Despite being most frequently born at high-level, high-volume centers, Non-Hispanic Black (NHB) neonates were overrepresented at hospitals with high RAMMR and all other groups were overrepresented at hospitals with lower RAMMR. Differences were most pronounced in the low-level and/or low-volume cohort.

Conclusion

NHB VLBW infants born at hospitals with low-level and/or low-volume NICUs are disproportionately exposed to adverse outcomes and must be the focus of future policy interventions.