The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes

Lorch, Scott A.; Enlow, Elizabeth

doi:10.1038/pr.2015.199

Cited by 126 publications

(97 citation statements)

References 73 publications

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“…33 We controlled for gestational age in the analyses because preterm birth is a complex disease with multiple causes that exhibits strong socioeconomic and spatial patterning at the population level. 34 As reduced birth weight shares many of these same causes, we hope to have limited the potential for bias from spatial confounding by controlling for gestational age. Furthermore, gestational age is very strongly correlated with birth weight, and controlling for gestational age greatly improves the precision of the association estimates.…”

Section: Discussionmentioning

confidence: 99%

Measurement Error Correction for Predicted Spatiotemporal Air Pollution Exposures

et al. 2017

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Background Air pollution cohort studies are frequently analyzed in two stages, first modeling exposure then using predicted exposures to estimate health effects in a second regression model. The difference between predicted and unobserved true exposures introduces a form of measurement error in the second stage health model. Recent methods for spatial data correct for measurement error with a bootstrap and by requiring the study design ensure spatial compatibility, i.e., monitor and subject locations are drawn from the same spatial distribution. These methods have not previously been applied to spatiotemporal exposure data. Methods We analyzed the association between fine particulate matter (PM2.5) and birth weight in the U.S. state of Georgia using records with estimated date of conception during 2002–2005 (n=403,881). We predicted trimester-specific PM2.5 exposure using a complex spatiotemporal exposure model. To improve spatial compatibility, we restricted to mothers residing in counties with a PM2.5 monitor (n=180,440). We accounted for additional measurement error via a non-parametric bootstrap. Results Third-trimester PM2.5 exposure was associated with lower birth weight in the uncorrected (−2.4g per 1 μg/m3 difference in exposure; 95% Confidence Interval [CI]: −3.9, −0.8) and bootstrap-corrected (−2.5g, 95% CI: −4.2, −0.8) analyses. Results for the unrestricted analysis were attenuated (−0.66g, 95% CI: −1.7, 0.35). Conclusions This study presents a novel application of measurement error correction for spatiotemporal air pollution exposures. Our results demonstrate the importance of spatial compatibility between monitor and subject locations and provide evidence of the association between air pollution exposure and birth weight.

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Section: Discussionmentioning

confidence: 99%

Measurement Error Correction for Predicted Spatiotemporal Air Pollution Exposures

et al. 2017

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“…Although we adjusted for some social factors likely associated with infant outcomes, others (eg, crime, neighborhood poverty, and environmental toxins) were not available in our data set. 36 Furthermore, our cross-sectional data could not evaluate trends and did not include fetal deaths. Nevertheless, we conducted a population-based study based on linked data and were able to construct a robust risk-adjustment model that included important social and clinical confounders and documented that racial/ethnic disparities in hospital of birth continue.…”

Section: Limitationsmentioning

confidence: 99%

Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals

et al. 2018

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IMPORTANCE Substantial quality improvements in neonatal care have occurred over the past decade yet racial and ethnic disparities in morbidity and mortality remain. It is uncertain whether disparate patterns of care by race and ethnicity contribute to disparities in neonatal outcomes. OBJECTIVES To examine differences in neonatal morbidity and mortality rates among non-Hispanic black (black), Hispanic, and non-Hispanic white (white) very preterm infants and to determine whether these differences are explained by site of delivery. DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective cohort study of 7177 nonanomalous infants born between 24 and 31 completed gestational weeks in 39 New York City hospitals using linked 2010 to 2014 New York City discharge abstract and birth certificate data sets. Mixed-effects logistic regression with a random hospital-specific intercept was used to generate risk-adjusted neonatal morbidity and mortality rates for very preterm infants in each hospital. Hospitals were ranked using this measure, and differences in the distribution of black, Hispanic, and white very preterm births were assessed among these hospitals. The statistical analysis was performed in 2016-2017. EXPOSURE Race/ethnicity. MAIN OUTCOMES AND MEASURES Composite of mortality (neonatal or in-hospital up to 1 year) or severe neonatal morbidity (bronchopulmonary dysplasia, severe necrotizing enterocolitis, retinopathy of prematurity stage 3 or greater, or intraventricular hemorrhage grade 3 or greater). RESULTS Among 7177 very preterm births (VPTBs), morbidity and mortality occurred in 2011 (28%) and was higher among black (893 [32.2%]) and Hispanic (610 [28.1%]) than white (319 [22.5%]) VPTBs (2-tailed P < .001). The risk-standardized morbidity and mortality rate was twice as great for VPTB infants born in hospitals in the highest morbidity and mortality tertile (0.40; 95% CI, 0.38-0.41) as for those born in the lowest morbidity and mortality tertile (0.16; 95% CI, 0.14-0.18). Black (1204 of 2775 [43.4%]) and Hispanic (746 of 2168 [34.4%]) VPTB infants were more likely than white (325 of 1418 [22.9%]) VPTB infants to be born in hospitals in the highest morbidity and mortality tertile (2-tailed P < .001; black-white difference, 20%; 95% CI, 18%-23% and Hispanic-white difference, 11%; 95% CI, 9%-14%). The largest proportion of the explained disparities can be attributed to differences in infant health risks among black, Hispanic, and white VPTB infants. However, 40% (95% CI, 30%-50%) of the black-white disparity and 30% (95% CI, 10%-49%) of the Hispanic-white disparity was explained by birth hospital. CONCLUSIONS AND RELEVANCE Black and Hispanic VPTB infants are more likely to be born at hospitals with higher risk-adjusted neonatal morbidity and mortality rates, and these differences contribute to excess morbidity and mortality among black and Hispanic infants.

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“…[32][33][34][35] These communities of women are concentrated in specific areas of the County, with 60%-70% of the population estimated to live in slums. 35 36 Population data on the demographic, socioeconomic and risk factor characteristics of the Nairobi population are, however, limited in their accuracy and granularity.…”

Section: Weak Population Datamentioning

confidence: 99%

Estimating the need for inpatient neonatal services: an iterative approach employing evidence and expert consensus to guide local policy in Kenya

et al. 2017

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Universal access to quality newborn health services will be essential to meeting specific Sustainable Development Goals to reduce neonatal and overall child mortality. Data for decision making are crucial for planning services and monitoring progress in these endeavours. However, gaps in local population-level and facility-based data hinder estimation of health service requirements for effective planning in many low-income and middle-income settings.We worked with local policy makers and experts in Nairobi City County, an area with a population of four million and the highest neonatal mortality rate amongst counties in Kenya, to address this gap, and developed a systematic approach to use available data to support policy and planning. We developed a framework to identify major neonatal conditions likely to require inpatient neonatal care and identified estimates of incidence through literature review and expert consultation, to give an overall estimate for the year 2017 of the need for inpatient neonatal care, taking account of potential comorbidities.Our estimates suggest that almost 1 in 5 newborns (183/1000 live births) in Nairobi City County may need inpatient care, resulting in an estimated 24 161 newborns expected to require care in 2017. Our approach has been well received by local experts, who showed a willingness to work together and engage in the use of evidence in healthcare planning. The process highlighted the need for co-ordinated thinking on admission policy and referral care especially in a pluralistic provider environment helping build further appetite for data-informed decision making.

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The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes

Cited by 126 publications

References 73 publications

Measurement Error Correction for Predicted Spatiotemporal Air Pollution Exposures

Measurement Error Correction for Predicted Spatiotemporal Air Pollution Exposures

Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals

Estimating the need for inpatient neonatal services: an iterative approach employing evidence and expert consensus to guide local policy in Kenya

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