Racial, ethnic, socioeconomic inequalities continue to impact preterm infant mortality
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Key takeaways:
- The study focused on 12,256,303 preterm infants born between 1995 and 2020.
- Preterm infant mortality fell overall, but Black infants were approximately 1.4 times more likely to die from prematurity than white infants.
Findings from a retrospective study revealed that preterm infant mortality in the United States improved in all prematurity categories from 1995 to 2020, but that racial, ethnic and socioeconomic inequalities continued.
“We wanted to understand whether the known differences in preterm infant health outcomes relating to their race and socioeconomic circumstance were changing over time — such as inequalities increasing, staying the same or decreasing — and this is the first step toward providing a mandate for health policy to reduce such health inequalities,” Tim Venkatesan, MA, MB, BChir, DTM&H, from the UCL Great Ormond Street Institute of Child Health in London, told Healio. “The U.S. — due to standardized processes for birth data collection — had the perfect dataset available for us to do this.”
In a retrospective, longitudinal, descriptive study, Venkatesan and colleagues used data from the U.S. National Center for Health and Statistics to examine birth infant/death data from 12,256,303 preterm infants spanning 1995 and 2020. Only infants born at 22 weeks or later were included, and infants were grouped based on age at birth, with those born between 22 and less than 37 weeks categorized as the total preterm group. The researchers further categorized infants into three subgroups: moderately preterm (born 32 to < 37 weeks), very preterm (born 28 to < 32 weeks) or extremely preterm (born 22 to < 28 weeks).
Venkatesan and colleagues found that mortality rates among preterm infants declined substantially during the study period (1995-1997: 33.71 per 1,000 live births vs. 2018-2020: 23.32 per 1,000 live births). Most prominent rates of improvement were seen in very preterm infants (−0.014; 95% CI, −0.016 to −0.013) and extremely preterm infants (−0.014; 95% CI, −0.015 to −0.013), although the researchers found that mortality rates increased steeply with decreasing gestational age. Further, while the researchers found that the rate of decrease in preterm infant mortality rate was highest in Black infants vs. white or Hispanic infants (−0.015 vs. −0.013 vs. −0.010, respectively), Black infants did not experience a change in relative risk for preterm infant mortality rate between 1995-1997 and 2018-2020 compared with white infants.
Black infants were also approximately 1.4 times more likely to die from prematurity than white infants, a finding Venkatesan and colleagues called concerning and said could be “partially attributed to a higher proportion of Black infants being born at the extremes of prematurity.” They also found, however, that once born, extremely premature Black and Hispanic infants experienced a narrow survival advantage over white infants (2018-2020: rate ratio, 0.87; 95% CI, 0.84-0.91).
As time progressed, researchers found there was a greater rate of decrease in preterm infant mortality rate among mothers who were nonsmokers vs. smokers (−0.015 vs. −0.01), had high vs. intermediate or low education (−0.016 vs. −0.01 vs. −0.011), and in those who received adequate vs. intermediate or inadequate antenatal care (−0.014 vs. −0.012 vs. −0.013). Also, the preterm mortality relative risk widened over time across all subgroups, with inadequate antenatal care consistently having the highest rate of preterm birth across subgroups.
“Reducing racial inequalities in preterm infant mortality is a major public health problem in the United States,” Venkatesan and colleagues wrote.
“It is important to recognize that health outcomes of preterm infants from different groups … are not equal,” Venkatesan told Healio. “We clearly show the importance of reducing maternal smoking, improving access to adequate antenatal care and the benefits of maternal education to preterm health outcomes. We would encourage all local health providers to consider the reasons behind why infants may have variable outcomes in preterm health and how they can improve local health policy and care pathways to account for this.”
In an accompanying editorial, Heather H. Burris, MD, MPH, a researcher and attending neonatologist at Children’s Hospital of Philadelphia and professor of pediatrics at the University of Pennsylvania Perelman School of Medicine, praised the authors’ “rigorous, descriptive, epidemiologic analysis” of the data.
“Venkatesan, et al succeed in highlighting that while there have been massive improvements in preterm infant mortality over the last 25 years, there is more work to do to achieve equity,” Burris wrote. “Relentless efforts to reduce preterm birth itself and to optimize health after preterm birth are needed to reduce preterm infant mortality and its disparities. Obstetricians and midwives should optimize maternal care and neonatologists and pediatricians should optimize preterm infant care, but these efforts will be insufficient to maximize preterm infant mortality prevention. Achievement of population-level improvements in outcomes will require investment in population-level interventions.”
Reference:
Burris HH, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.3493.
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