Vermont Oxford Network, Burlington.
Department of Pediatrics, Robert Larner MD College of Medicine, University of Vermont, Burlington.
JAMA Pediatr. 2019 May 1;173(5):455-461. doi: 10.1001/jamapediatrics.2019.0241.
Racial and ethnic minorities receive lower-quality health care than white non-Hispanic individuals in the United States. Where minority infants receive care and the role that may play in the quality of care received is unclear.
To determine the extent of segregation and inequality of care of very low-birth-weight and very preterm infants across neonatal intensive care units (NICUs) in the United States.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study of 743 NICUs in the Vermont Oxford Network included 117 982 black, Hispanic, Asian, and white infants born at 401 g to 1500 g or 22 to 29 weeks' gestation from January 2014 to December 2016. Analysis began January 2018.
The NICU segregation index and NICU inequality index were calculated at the hospital level as the Gini coefficients associated with the Lorenz curves for black, Hispanic, and Asian infants compared with white infants, with NICUs ranked by proportion of white infants for the NICU segregation index and by composite Baby-MONITOR (Measure of Neonatal Intensive Care Outcomes Research) score for the NICU inequality index.
Infants (36 359 black [31%], 21 808 Hispanic [18%], 5920 Asian [5%], and 53 895 white [46%]) were segregated among the 743 NICUs by race and ethnicity (NICU segregation index: black: 0.50 [95% CI, 0.46-0.53], Hispanic: 0.58 [95% CI, 0.54-0.61], and Asian: 0.45 [95% CI, 0.40-0.50]). Compared with white infants, black infants were concentrated at NICUs with lower-quality scores, and Hispanic and Asian infants were concentrated at NICUs with higher-quality scores (NICU inequality index: black: 0.07 [95% CI, 0.02-0.13], Hispanic: -0.10 [95% CI, -0.17 to -0.04], and Asian: -0.26 [95% CI, -0.32 to -0.19]). There was marked variation among the census regions in weighted mean NICU quality scores (range: -0.69 to 0.85). Region of residence explained the observed inequality for Hispanic infants but not for black or Asian infants.
Black, Hispanic, and Asian infants were segregated across NICUs, reflecting the racial segregation of minority populations in the United States. There were large differences between geographic regions in NICU quality. After accounting for these differences, compared with white infants, Asian infants received care at higher-quality NICUs and black infants, at lower-quality NICUs. Explaining these patterns will require understanding the effects of sociodemographic factors and public policies on hospital quality, access, and choice for minority women and their infants.
在美国，少数族裔和少数民族所接受的医疗保健质量低于白人非西班牙裔个体。少数族裔婴儿在哪里接受护理，以及这在接受的护理质量中可能扮演的角色尚不清楚。
确定美国新生儿重症监护病房（NICU）中极低出生体重和极早产儿的隔离程度和护理不平等程度。
设计、地点和参与者：这项在美国牛津网络中的 743 家 NICU 中进行的队列研究纳入了 2014 年 1 月至 2016 年 12 月期间出生于 401 克至 1500 克或 22 至 29 周胎龄的 117982 名黑种人、西班牙裔、亚洲人和白人婴儿。分析于 2018 年 1 月开始。
在医院层面计算了 NICU 隔离指数和 NICU 不平等指数，方法是将与白种人婴儿相比，黑种人、西班牙裔和亚洲人婴儿的洛伦兹曲线相关的基尼系数进行比较，其中 NICU 按白种人婴儿的比例进行 NICU 隔离指数排名，按复合婴儿监测器（衡量新生儿重症监护结果研究的工具）评分进行 NICU 不平等指数排名。
743 家 NICU 中的婴儿（36359 名黑种人[31%]、21808 名西班牙裔[18%]、5920 名亚洲人[5%]和 53895 名白人[46%]）按种族和民族被隔离（NICU 隔离指数：黑种人：0.50[95%CI，0.46-0.53]；西班牙裔：0.58[95%CI，0.54-0.61]；亚洲人：0.45[95%CI，0.40-0.50]）。与白人婴儿相比，黑种人婴儿集中在护理质量较低的 NICU，而西班牙裔和亚洲婴儿集中在护理质量较高的 NICU（NICU 不平等指数：黑种人：0.07[95%CI，0.02-0.13]；西班牙裔：-0.10[95%CI，-0.17 至-0.04]；亚洲人：-0.26[95%CI，-0.32 至-0.19]）。按加权平均 NICU 质量评分（范围：-0.69 至 0.85），各普查区域之间存在明显差异。居住地区解释了西班牙裔婴儿的观察到的不平等现象，但对黑种人和亚洲婴儿没有解释。
黑种人、西班牙裔和亚洲婴儿在 NICU 中被隔离，反映了美国少数族裔人口的种族隔离。NICU 质量在地理位置上存在较大差异。在考虑到这些差异后，与白人婴儿相比，亚洲婴儿在护理质量较高的 NICU 中接受护理，而黑种婴儿在护理质量较低的 NICU 中接受护理。要解释这些模式，需要了解社会人口因素和公共政策对少数族裔妇女及其婴儿的医院质量、可及性和选择的影响。
