Race, Ethnicity, Concentrated Poverty, and Low Birth Weight Disparities

AbstractTo examine temporal trends of NICU admissions in the U.S. by race/ethnicity, we conducted a retrospective cohort analysis using natality files provided by the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention. A total of 38,011,843 births in 2008–2018 were included. Crude and risk-adjusted NICU admission rates, overall and stratified by birth weight group, were compared between white, black, and Hispanic infants. Crude NICU admission rates increased from 6.62% (95% CI 6.59–6.65) to 9.07% (95% CI 9.04–9.10) between 2008 and 2018. The largest percentage increase was observed among Hispanic infants (51.4%) compared to white (29.1%) and black (32.4%) infants. Overall risk-adjusted rates differed little by race/ethnicity, but birth weight-stratified analysis revealed that racial/ethnic differences diminished in the very low birth weight (< 1500 g) and moderately low birth weight (1500–2499 g) groups. Overall NICU admission rates increased by 37% from 2008 to 2018, and the increasing trends were observed among all racial and ethnic groups. Diminished racial/ethnic differences in NICU admission rates in very low birth weight infants may reflect improved access to timely appropriate NICU care among high-risk infants through increasing health care coverage coupled with growing NICU supply.

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Association of Rural and Frontier Residence with Very Preterm and Very Low Birth Weight Delivery in Nonlevel III NICUs

American Journal of Perinatology ◽

10.1055/s-0041-1727222 ◽

2021 ◽

Author(s):

Stephanie L. Bourque ◽

Blair W. Weikel ◽

Kristin Crispe ◽

Sunah S. Hwang

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Neonatal Intensive Care ◽

Very Low Birth Weight ◽

Birth Certificate ◽

Chi Square ◽

Very Preterm ◽

Key Points ◽

Race Ethnicity ◽

Independent Association

Objective Delivery of very preterm and very low birth weight neonates (VPT/VLBW) in a nonlevel III neonatal intensive care unit (NICU) increases risk of morbidity and mortality. Study objectives included: (1) Determine incidence of VPT/VLBW delivery (<32 weeks gestational age and/or birth weight <1,500 g), in nonlevel III units in Colorado; (2) Evaluate the independent association between residence and nonlevel III unit delivery; (3) Determine the incidence of and factors associated with postnatal transfer. Study Design This retrospective cohort study used 2007 to 2016 Colorado birth certificate data. Demographic and clinical characteristics by VPT/VLBW delivery in level III NICUs versus nonlevel III units were compared using Chi-square analyses. Multivariable logistic regression was used to estimate the independent association between residence and VPT/VLBW delivery. Results 897 of 10,015 (8.96%) VPT/VLBW births occurred in nonlevel III units. Compared with infants born to pregnant persons in urban counties, infants born to those residing in rural (adjusted odds ratio or AOR 1.58, 95% confidence interval or CI 1.33, 1.88) or frontier (AOR 3.19, 95% CI 2.14, 4.75) counties were more likely to deliver in nonlevel III units and to experience postnatal transfer within 24 hours (rural AOR 2.24, 95% CI 1.60, 3.15; frontier AOR 3.91, 95% CI 1.76, 8.67). Compared with non-Hispanic whites, Hispanics were more likely to deliver VPT/VLBW infants in nonlevel III units (AOR 1.36, 95% CI 1.15, 1.61). Conclusion A significant number of VPT/VLBW neonates were born in nonlevel III units with associated disparities by race/ethnicity and nonurban residence. Key Points

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Retrospective cohort study of the association between maternal employment precarity and infant low birth weight in women in the USA

BMJ Open ◽

10.1136/bmjopen-2019-029584 ◽

2020 ◽

Vol 10 (1) ◽

pp. e029584 ◽

Cited By ~ 1

Author(s):

Divya Patil ◽

Daniel A Enquobahrie ◽

Trevor Peckham ◽

Noah Seixas ◽

Anjum Hajat

Keyword(s):

Birth Weight ◽

Black Women ◽

Low Birth Weight ◽

Maternal Employment ◽

Bargaining Unit ◽

Longitudinal Survey ◽

National Longitudinal Survey ◽

High Employment ◽

Race Ethnicity ◽

Infant Low Birth Weight

ObjectivesTo investigate the association between maternal employment precarity and infant low birth weight (LBW), and to assess if this association differs by race/ethnicity.MethodsData were collected from 2871 women enrolled in the National Longitudinal Survey of Youth 1979 and the National Longitudinal Survey of Youth 1979 Children and Young Adult Cohort. Employment precarity was evaluated using a summary variable that combined several employment attributes: availability of employer-sponsored insurance, income, long shifts, non-daytime shifts, availability of employer sponsored training or educational benefits and membership in a union or collective bargaining unit. Employment precarity scores (a sum of the number of negative employment attributes) were categorised into low (0–2), medium (3) and high (4-6). LBW was defined as weight less than 2500 g at birth. Modified Poisson models were fit to calculate risk ratios and 95% CIs and adjusted for maternal age, race/ethnicity, educational attainment, nativity, prepregnancy body mass index, alcohol consumption, smoking during pregnancy and infant year of birth. We assessed effect modification by maternal race/ethnicity using a composite exposure-race variable.ResultsWomen with high employment precarity had higher risk of a LBW delivery compared with women with low employment precarity (RR: 1.48, 95% CI: 1.11 to 1.98). Compared to non-Hispanic/non-black women with low employment precarity, non-Hispanic black women (RR: 2.68; 95% CI: 1.72 to 4.15), Hispanic women (RR: 2.53; 95% CI: 1.54 to 4.16) and non-Hispanic/non-black women (RR: 1.46; 95% CI: 0.98 to 2.16) with high employment precarity had higher risk of LBW.ConclusionsWe observed higher risk of LBW in pregnancies of women with high employment precarity; this association was stronger among black and Hispanic mothers compared to non-Hispanic/non-black women. Findings of this study can be used to inform antenatal care and identify workplace policies to better support women who work during pregnancy.

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