Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates
Background Racial disparities in preterm neonatal mortality are long-standing. We aimed to assess how cohort selection influences mortality rates and racial disparity estimates. Methods With 2014–2018 California data, we compared neonatal mortality rates among Black and non-Hispanic White very low b...
Gespeichert in:
| Veröffentlicht in: | Pediatric research 2024-02, Vol.95 (3), p.792-801 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 801 |
|---|---|
| container_issue | 3 |
| container_start_page | 792 |
| container_title | Pediatric research |
| container_volume | 95 |
| creator | Gould, Jeffrey B. Bennett, Mihoko V. Profit, Jochen Lee, Henry C. |
| description | Background
Racial disparities in preterm neonatal mortality are long-standing. We aimed to assess how cohort selection influences mortality rates and racial disparity estimates.
Methods
With 2014–2018 California data, we compared neonatal mortality rates among Black and non-Hispanic White very low birth weight (VLBW, |
| doi_str_mv | 10.1038/s41390-023-02766-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10899100</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2851143178</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-f7e766087e82059a2eea7cb4a45e07ef8cdf5843cef1fedd4a459b2498f12ce03</originalsourceid><addsrcrecordid>eNp9kU1vVCEUhomxsWP1D7gwJG7cXMtngZUxE7-SJt3omjDcQ4fmXhiBMZ1_L7dT68eiC0I45-HlvLwIvaLkHSVcn1dBuSEDYbwvdXExkCdoRSXvJSHUU7QihNOBG6NP0fNabwihQmrxDJ1yJTWRkq3QZp23uTRcYQLfYk7YpRG3LWCoLc7urpQDLs5HN-Ex1p0rsR1wTHjuF920HDoAt63ADNMB7wo0KDNOkJNrUF-gk-CmCi_v9zP0_dPHb-svw-XV56_rD5eDF0q2ISjoHohWoBmRxjEAp_xGOCGBKAjaj6FPzz0EGmAcl4bZMGF0oMwD4Wfo_VF3t9_MMHpIrbjJ7kq3UQ42u2j_7aS4tdf5p6VEG0PJovD2XqHkH_v-AXaO1cM0ue5lXy3TklLBqdIdffMfepP3JXV_lhnOOkMN6xQ7Ur7kWguEh2kosUuG9pih7RnauwztMsXrv308XPkdWgf4Eai9la6h_Hn7EdlfxNOqBg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2932317192</pqid></control><display><type>article</type><title>Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Gould, Jeffrey B. ; Bennett, Mihoko V. ; Profit, Jochen ; Lee, Henry C.</creator><creatorcontrib>Gould, Jeffrey B. ; Bennett, Mihoko V. ; Profit, Jochen ; Lee, Henry C.</creatorcontrib><description>Background
Racial disparities in preterm neonatal mortality are long-standing. We aimed to assess how cohort selection influences mortality rates and racial disparity estimates.
Methods
With 2014–2018 California data, we compared neonatal mortality rates among Black and non-Hispanic White very low birth weight (VLBW, <1500 g) or very preterm infants (22–29 weeks gestational age). Relative risks were estimated by different cohort selection criteria. Blinder-Oaxaca decomposition quantified factors contributing to mortality differential.
Results
Depending upon standard selection criteria, mortality ranged from 6.2% (VLBW infants excluding first 12-h deaths) to 16.0% (22–29 weeks’ gestation including all deaths). Black observed neonatal mortality was higher than White infants only for delivery room deaths in VLBW infants (5.6 vs 4.2%). With risk adjustment accounting for higher rate of low gestational age, low Apgar score and other factors, White infant mortality increased from 15.9 to 16.6%, while Black infant mortality decreased from 16.7 to 13.7% in the 22–29 weeks cohort. Across varying cohort selection, risk adjusted survival advantage among Black infants ranged from 0.70 (CL 0.61–0.80) to 0.84 (CL 0.76–0.93).
Conclusions
Standard cohort selection can give markedly different mortality estimates. It is necessary to reduce prematurity rates and perinatal morbidity to improve outcomes for Black infants.
Impact
In this population-based observational cohort study that encompassed very low birth weight infant hospitalizations in California, varying standard methods of cohort selection resulted in neonatal mortality ranges from 6.2 to 16.0%.
Across all cohorts, the only significant observed Black-White disparity was for delivery room deaths in Very Low Birth Weight births (5.6 vs 4.2%).
Across all cohorts, we found a 16–30% survival advantage for Black infants.
Cohort selection can result in an almost three-fold difference in estimated mortality but did not have a meaningful impact on observed or adjusted differences in neonatal mortality outcomes by race and ethnicity.</description><identifier>ISSN: 0031-3998</identifier><identifier>EISSN: 1530-0447</identifier><identifier>DOI: 10.1038/s41390-023-02766-0</identifier><identifier>PMID: 37580552</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>Apgar score ; Babies ; Birth weight ; Cohort analysis ; Ethnicity ; Female ; Gestational age ; Health disparities ; Humans ; Inequality ; Infant ; Infant Mortality ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Very Low Birth Weight ; Medicine ; Medicine & Public Health ; Morbidity ; Mortality ; Observational studies ; Pediatric Surgery ; Pediatrics ; Population Study ; Population Study Article ; Pregnancy ; Premature babies ; Racial differences ; Survival analysis ; White</subject><ispartof>Pediatric research, 2024-02, Vol.95 (3), p.792-801</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-f7e766087e82059a2eea7cb4a45e07ef8cdf5843cef1fedd4a459b2498f12ce03</citedby><cites>FETCH-LOGICAL-c475t-f7e766087e82059a2eea7cb4a45e07ef8cdf5843cef1fedd4a459b2498f12ce03</cites><orcidid>0000-0001-8383-1720</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/s41390-023-02766-0$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/s41390-023-02766-0$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37580552$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gould, Jeffrey B.</creatorcontrib><creatorcontrib>Bennett, Mihoko V.</creatorcontrib><creatorcontrib>Profit, Jochen</creatorcontrib><creatorcontrib>Lee, Henry C.</creatorcontrib><title>Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates</title><title>Pediatric research</title><addtitle>Pediatr Res</addtitle><addtitle>Pediatr Res</addtitle><description>Background
Racial disparities in preterm neonatal mortality are long-standing. We aimed to assess how cohort selection influences mortality rates and racial disparity estimates.
Methods
With 2014–2018 California data, we compared neonatal mortality rates among Black and non-Hispanic White very low birth weight (VLBW, <1500 g) or very preterm infants (22–29 weeks gestational age). Relative risks were estimated by different cohort selection criteria. Blinder-Oaxaca decomposition quantified factors contributing to mortality differential.
Results
Depending upon standard selection criteria, mortality ranged from 6.2% (VLBW infants excluding first 12-h deaths) to 16.0% (22–29 weeks’ gestation including all deaths). Black observed neonatal mortality was higher than White infants only for delivery room deaths in VLBW infants (5.6 vs 4.2%). With risk adjustment accounting for higher rate of low gestational age, low Apgar score and other factors, White infant mortality increased from 15.9 to 16.6%, while Black infant mortality decreased from 16.7 to 13.7% in the 22–29 weeks cohort. Across varying cohort selection, risk adjusted survival advantage among Black infants ranged from 0.70 (CL 0.61–0.80) to 0.84 (CL 0.76–0.93).
Conclusions
Standard cohort selection can give markedly different mortality estimates. It is necessary to reduce prematurity rates and perinatal morbidity to improve outcomes for Black infants.
Impact
In this population-based observational cohort study that encompassed very low birth weight infant hospitalizations in California, varying standard methods of cohort selection resulted in neonatal mortality ranges from 6.2 to 16.0%.
Across all cohorts, the only significant observed Black-White disparity was for delivery room deaths in Very Low Birth Weight births (5.6 vs 4.2%).
Across all cohorts, we found a 16–30% survival advantage for Black infants.
Cohort selection can result in an almost three-fold difference in estimated mortality but did not have a meaningful impact on observed or adjusted differences in neonatal mortality outcomes by race and ethnicity.</description><subject>Apgar score</subject><subject>Babies</subject><subject>Birth weight</subject><subject>Cohort analysis</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Gestational age</subject><subject>Health disparities</subject><subject>Humans</subject><subject>Inequality</subject><subject>Infant</subject><subject>Infant Mortality</subject><subject>Infant, Extremely Premature</subject><subject>Infant, Newborn</subject><subject>Infant, Very Low Birth Weight</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Population Study</subject><subject>Population Study Article</subject><subject>Pregnancy</subject><subject>Premature babies</subject><subject>Racial differences</subject><subject>Survival analysis</subject><subject>White</subject><issn>0031-3998</issn><issn>1530-0447</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU1vVCEUhomxsWP1D7gwJG7cXMtngZUxE7-SJt3omjDcQ4fmXhiBMZ1_L7dT68eiC0I45-HlvLwIvaLkHSVcn1dBuSEDYbwvdXExkCdoRSXvJSHUU7QihNOBG6NP0fNabwihQmrxDJ1yJTWRkq3QZp23uTRcYQLfYk7YpRG3LWCoLc7urpQDLs5HN-Ex1p0rsR1wTHjuF920HDoAt63ADNMB7wo0KDNOkJNrUF-gk-CmCi_v9zP0_dPHb-svw-XV56_rD5eDF0q2ISjoHohWoBmRxjEAp_xGOCGBKAjaj6FPzz0EGmAcl4bZMGF0oMwD4Wfo_VF3t9_MMHpIrbjJ7kq3UQ42u2j_7aS4tdf5p6VEG0PJovD2XqHkH_v-AXaO1cM0ue5lXy3TklLBqdIdffMfepP3JXV_lhnOOkMN6xQ7Ur7kWguEh2kosUuG9pih7RnauwztMsXrv308XPkdWgf4Eai9la6h_Hn7EdlfxNOqBg</recordid><startdate>20240201</startdate><enddate>20240201</enddate><creator>Gould, Jeffrey B.</creator><creator>Bennett, Mihoko V.</creator><creator>Profit, Jochen</creator><creator>Lee, Henry C.</creator><general>Nature Publishing Group US</general><general>Nature Publishing Group</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8383-1720</orcidid></search><sort><creationdate>20240201</creationdate><title>Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates</title><author>Gould, Jeffrey B. ; Bennett, Mihoko V. ; Profit, Jochen ; Lee, Henry C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-f7e766087e82059a2eea7cb4a45e07ef8cdf5843cef1fedd4a459b2498f12ce03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Apgar score</topic><topic>Babies</topic><topic>Birth weight</topic><topic>Cohort analysis</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Gestational age</topic><topic>Health disparities</topic><topic>Humans</topic><topic>Inequality</topic><topic>Infant</topic><topic>Infant Mortality</topic><topic>Infant, Extremely Premature</topic><topic>Infant, Newborn</topic><topic>Infant, Very Low Birth Weight</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Observational studies</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Population Study</topic><topic>Population Study Article</topic><topic>Pregnancy</topic><topic>Premature babies</topic><topic>Racial differences</topic><topic>Survival analysis</topic><topic>White</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gould, Jeffrey B.</creatorcontrib><creatorcontrib>Bennett, Mihoko V.</creatorcontrib><creatorcontrib>Profit, Jochen</creatorcontrib><creatorcontrib>Lee, Henry C.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatric research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gould, Jeffrey B.</au><au>Bennett, Mihoko V.</au><au>Profit, Jochen</au><au>Lee, Henry C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates</atitle><jtitle>Pediatric research</jtitle><stitle>Pediatr Res</stitle><addtitle>Pediatr Res</addtitle><date>2024-02-01</date><risdate>2024</risdate><volume>95</volume><issue>3</issue><spage>792</spage><epage>801</epage><pages>792-801</pages><issn>0031-3998</issn><eissn>1530-0447</eissn><abstract>Background
Racial disparities in preterm neonatal mortality are long-standing. We aimed to assess how cohort selection influences mortality rates and racial disparity estimates.
Methods
With 2014–2018 California data, we compared neonatal mortality rates among Black and non-Hispanic White very low birth weight (VLBW, <1500 g) or very preterm infants (22–29 weeks gestational age). Relative risks were estimated by different cohort selection criteria. Blinder-Oaxaca decomposition quantified factors contributing to mortality differential.
Results
Depending upon standard selection criteria, mortality ranged from 6.2% (VLBW infants excluding first 12-h deaths) to 16.0% (22–29 weeks’ gestation including all deaths). Black observed neonatal mortality was higher than White infants only for delivery room deaths in VLBW infants (5.6 vs 4.2%). With risk adjustment accounting for higher rate of low gestational age, low Apgar score and other factors, White infant mortality increased from 15.9 to 16.6%, while Black infant mortality decreased from 16.7 to 13.7% in the 22–29 weeks cohort. Across varying cohort selection, risk adjusted survival advantage among Black infants ranged from 0.70 (CL 0.61–0.80) to 0.84 (CL 0.76–0.93).
Conclusions
Standard cohort selection can give markedly different mortality estimates. It is necessary to reduce prematurity rates and perinatal morbidity to improve outcomes for Black infants.
Impact
In this population-based observational cohort study that encompassed very low birth weight infant hospitalizations in California, varying standard methods of cohort selection resulted in neonatal mortality ranges from 6.2 to 16.0%.
Across all cohorts, the only significant observed Black-White disparity was for delivery room deaths in Very Low Birth Weight births (5.6 vs 4.2%).
Across all cohorts, we found a 16–30% survival advantage for Black infants.
Cohort selection can result in an almost three-fold difference in estimated mortality but did not have a meaningful impact on observed or adjusted differences in neonatal mortality outcomes by race and ethnicity.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>37580552</pmid><doi>10.1038/s41390-023-02766-0</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-8383-1720</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0031-3998 |
| ispartof | Pediatric research, 2024-02, Vol.95 (3), p.792-801 |
| issn | 0031-3998 1530-0447 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10899100 |
| source | MEDLINE; Springer Nature - Complete Springer Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Apgar score Babies Birth weight Cohort analysis Ethnicity Female Gestational age Health disparities Humans Inequality Infant Infant Mortality Infant, Extremely Premature Infant, Newborn Infant, Very Low Birth Weight Medicine Medicine & Public Health Morbidity Mortality Observational studies Pediatric Surgery Pediatrics Population Study Population Study Article Pregnancy Premature babies Racial differences Survival analysis White |
| title | Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-14T19%3A25%3A53IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Cohort%20selection%20and%20the%20estimation%20of%20racial%20disparity%20in%20mortality%20of%20extremely%20preterm%20neonates&rft.jtitle=Pediatric%20research&rft.au=Gould,%20Jeffrey%20B.&rft.date=2024-02-01&rft.volume=95&rft.issue=3&rft.spage=792&rft.epage=801&rft.pages=792-801&rft.issn=0031-3998&rft.eissn=1530-0447&rft_id=info:doi/10.1038/s41390-023-02766-0&rft_dat=%3Cproquest_pubme%3E2851143178%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2932317192&rft_id=info:pmid/37580552&rfr_iscdi=true |