Black infants particularly at risk

Residential racial segregation is associated with an increased risk of intraventricular hemorrhage (IVH) in preterm infants, researchers found.

Unsurprisingly, Daria Murosko, MD, MPH, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and colleagues determined that black infants are especially at risk if their mothers live in racially segregated areas.

Their study was published in Pediatrics.

Intraventricular hemorrhages (IVH), particularly severe grades, increase the risk of mortality and lifelong neurocognitive impairment in premature infants. While rates of IVH have declined over the last several decades, at least a quarter of preterm infants are affected with some grade of IVH. And, black infants have an increased risk of IVH and twice the mortality rate compared to white infants.

According to Murosko and colleagues, the increased risk of IVH is associated with maternal factors such as chorioamnionitis and in vitro fertility treatment, as well as perinatal factors, such as lack of antenatal steroids and vaginal delivery. At the same time, residential racial segregation is known to account for some health disparities between black and white infants (including mortality and preterm birth rates).

“However, there is a paucity of research that has examined the impact of segregation on incidence of common morbidities of prematurity,” Murosko and colleagues pointed out. Therefore, here in this retrospective cohort study, they wanted to evaluate the association between residential racial segregation on disparities in IVH.

Using birth certificates linked to medical records in California, Missouri, and Pennsylvania between 1995 and 2009, the authors built a cohort of over 70,000 infants born between 24- and 32-weeks’ gestation. They used propensity score analysis (based on race, sociodemographic factors, and comorbidities) to match infants born to mothers in highly segregated areas to those in less segregated areas in order to compare IVH risk.

Of the 70,775 preterm infants in the study, 36.10% were born to non-Hispanic black mothers, and the remainder to non-Hispanic white mothers. Dissimilarity scores were used to divide individuals into quartiles ranging from those living with the highest degree of segregation to the lowest.

Mothers living in highly segregated areas were younger and more likely to have chorioamnionitis, pregnancy-induced hypertension, chronic hypertension, and preterm labor, while infants born in in the highest quartile of segregation had body weights that were significantly lower than those of infants in the lowest quartile.

In the entire study cohort, 11.4% of infants developed IVH. Murosko and colleagues found that infants born to mothers in the highest segregation quartile had a significantly greater risk of developing IVH compared to those born to mothers in the lowest quartile (12.9% versus 10.4%). While the rate of IVH increased with segregation, that increase was much greater for black infants (1.12% increase per quartile for black infants compared to 0.51% for white infants).

In the 17,918 pairs of infants matched on propensity scores, the risk of developing IVH was greater in the group exposed to a segregated environment (risk ratio = 1.08, 95% confidence interval: 1.01–1.15), with the effect stronger for black infants alone (risk ratio = 1.16; 95% confidence interval: 1.03–1.30).

From a public health standpoint, Murosko and colleagues acknowledged that while eliminating segregation will require substantial economic and political willpower, “pediatricians can effect change by employing an understanding of environmental barriers, including [residential racial segregation], to target evidence-based clinical interventions, advocate for policy changes, and provide community specific education.”

In an accompanying commentary, Jonathan S. Kitt, MD, MPH, ScD, Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and colleagues, noted that other studies have observed the adverse impact of segregation on the quality of care infants and families receive in birth hospitals and neonatal ICUs.

“These observations may underscore the importance of performing local quality improvement assessments through racial and social lenses, both because signals for opportunities for improvement may be missed when looking at total populations and because deviations from standard care may have greater implications for specific populations,” they wrote.

Questions regarding the social determinants of health should also be viewed with an “ethical frame,” added Kitt and his colleagues. “Applying a health equity frame forces us to give our scientific questions appropriate context and focus transdisciplinary efforts on developing theory-guided, evidence-based, and ethically sound solutions to improve outcomes for all children.”

  1. Residential racial segregation is associated with an increased risk of intraventriclar hemorrhage in preterm infants.

  2. Black preterm infants in particular are at an increased risk if their mothers live in highly segregated residential areas.

Michael Bassett, Contributing Writer, BreakingMED™

The authors had no relevant relationships to disclose.

Cat ID: 138

Topic ID: 85,138,585,138,192,462,925