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Universal bilirubin screening limited by economic disparities

The increase in follow-up care due to universal bilirubin screening in Canadian newborns was limited by socioeconomic disparities, according to recent findings published in Academic Pediatrics.

“Although the newborns in our study had universal health insurance, wealthier parents are still less likely to face cost barriers to getting their newborn to a follow-up visit,” Elizabeth Kathleen Darling, RM, PhD, in the Population Health Doctorate Program at the University of Ottawa, told Healio.com/Hepatology. “Wealthier parents are often also better educated, and may be more informed about the importance of arranging an early follow-up visit for their newborn.”

Elizabeth Kathleen Darling

To determine whether implementing universal bilirubin screening in Ontario would lead to improved follow-up rates across socioeconomic backgrounds, Darling and colleagues performed a cohort study of all babies born at 35 weeks of gestation or later and who were discharged within 3 days from 97 hospitals between 2003 and 2011 (n = 711,242). For each newborn, there were two options for recommended follow-up care:

• For babies discharged fewer than 24 hours after birth, a physician visit within 1 day of discharge; and
• For babies discharged between 24 and 72 hours after birth, a physician visit within 2 days of discharge.

To determine follow-up, the researchers used administrative health datasets. To assess socioeconomic status, they used maternal postal code and the Canadian Deprivation Index. Afterward, they modeled the relationship between universal bilirubin screening, follow-up and socioeconomic status.

Universal bilirubin screening was associated with an increase in follow-up from 29.9% to 35% (adjusted RR [aRR] = 1.11; P = .047). However, 40% of the increase in follow-up was attributable to the highest socioeconomic quintile and 0% was attributable to the lowest quintile.

The researchers concluded that universal bilirubin screening had only a modest impact. Further, the increase in socioeconomic disparity suggests that improvements in screening may lead to increased inequity.

“Improved coordination of care between hospitals and community care providers is needed so that follow-up appointments in the community are booked before newborns leave the hospital,” Darling said. “Having a process in place is necessary to ensure access to a follow-up visit for newborns whose parents have not been able to find a primary care provider for their newborn.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.