Cross-Sectional Analysis on Racial and Economic Disparities Affecting Mortality in Preterm Infants with Posthemorrhagic Hydrocephalus

Diana L Jin; Eisha A Christian; Frank Attenello; Edward Melamed; Steven Cen; Mark D Krieger; J Gordon McComb; William J Mack

doi:10.1016/j.wneu.2015.12.046

Cross-Sectional Analysis on Racial and Economic Disparities Affecting Mortality in Preterm Infants with Posthemorrhagic Hydrocephalus

World Neurosurg. 2016 Apr:88:399-410. doi: 10.1016/j.wneu.2015.12.046. Epub 2015 Dec 28.

Authors

Diana L Jin¹, Eisha A Christian², Frank Attenello², Edward Melamed³, Steven Cen², Mark D Krieger⁴, J Gordon McComb⁴, William J Mack²

Affiliations

¹ Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA. Electronic address: [email protected].
² Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA.
³ Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA.
⁴ Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA; Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA.

PMID: 26732967
DOI: 10.1016/j.wneu.2015.12.046

Abstract

Background: Despite major advances in medicine, racial and socioeconomic disparities continue to affect health care outcomes. Higher overall infant mortality has been reported for black neonates compared with their Hispanic and white counterparts. The underlying basis for these differences remains unclear. A potential influencing factor is the management of premature neurologic complications in this disadvantaged group. This study examines racial and socioeconomic disparities on mortality in preterm infants with posthemorrhagic hydrocephalus (PHH).

Methods: Data from the Nationwide Inpatient Sample and Kids Inpatient Database were combined from 2000 to 2010. Discharges with International Classification of Diseases, Ninth Revision, Clinical Modification codes for preterm births with intraventricular hemorrhage and PHH were included. Relative risk (RR) ratios for mortality, complications, length of stay, and hospital costs were obtained with multivariate analysis after controlling for patient-level, hospital-level, and admission-level factors.

Results: When controlling for patient and hospital factors, black neonates had increased mortality compared with whites and Hispanics (RR = 1.47; P < 0.01). This association existed despite lower rates of congenital cardiac defects (RR = 0.84; P < 0.01), gastrointestinal complications (RR = 0.84; P < 0.01), and general complications of prematurity (RR = 0.95; P = 0.04) in the black cohort. Preterm infants insured by Medicaid had increased mortality compared with those with private insurance (RR = 1.2; P = 0.04) after adjusting for patient and hospital factors.

Conclusions: Among preterm infants with intraventricular hemorrhage and resultant PHH, black infants and those insured by Medicaid have significantly increased mortality but these 2 effects are independent. Further studies are needed to fully understand the factors affecting these racial and socioeconomic disparities.

Keywords: Hydrocephalus; Intraventricular hemorrhage; Kids Inpatient Database; Nationwide Inpatient Sample; Posthemorrhagic hydrocephalus; Preterm infant; Preterm neonate.

MeSH terms

Causality
Cerebral Hemorrhage / diagnosis
Cerebral Hemorrhage / mortality*
Cerebral Hemorrhage / therapy*
Comorbidity
Cross-Sectional Studies
Female
Healthcare Disparities / ethnology*
Healthcare Disparities / statistics & numerical data
Humans
Hydrocephalus / diagnosis
Hydrocephalus / mortality*
Hydrocephalus / therapy*
Infant
Infant Mortality / ethnology*
Infant, Newborn
Infant, Premature
Male
Racial Groups / statistics & numerical data
Racism / statistics & numerical data
Risk Assessment
Sex Distribution
Socioeconomic Factors
Survival Rate
United States / ethnology