Black/white differences in very low birth weight neonatal mortality rates among New York City hospitals.
OBJECTIVE
We sought to determine whether differences in the hospitals at which black and white infants are born contribute to black/white disparities in very low birth weight neonatal mortality rates in New York City.


METHODS
We performed a population-based cohort study using New York City vital statistics records on all live births and deaths of infants weighing 500 to 1499 g who were born in 45 hospitals between January 1, 1996, and December 31, 2001 (N = 11 781). We measured very low birth weight risk-adjusted neonatal mortality rates for each New York City hospital and assessed differences in the distributions of non-Hispanic black and non-Hispanic white very low birth weight births among these hospitals.


RESULTS
Risk-adjusted neonatal mortality rates for very low birth weight infants in New York City hospitals ranged from 9.6 to 27.2 deaths per 1000 births. White very low birth weight infants were more likely to be born in the lowest mortality tertile of hospitals (49%), compared with black very low birth weight infants (29%). We estimated that, if black women delivered in the same hospitals as white women, then black very low birth weight mortality rates would be reduced by 6.7 deaths per 1000 very low birth weight births, removing 34.5% of the black/white disparity in very low birth weight neonatal mortality rates in New York City. Volume of very low birth weight deliveries was modestly associated with very low birth weight mortality rates but explained little of the racial disparity.


CONCLUSIONS
Black very low birth weight infants more likely to be born in New York City hospitals with higher risk-adjusted neonatal mortality rates than were very low birth weight infants, contributing substantially to black-white disparities.
Howell
Elizabeth A
EA
Department of Health Policy, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1077, New York, NY 10029-6574, USA. elizabeth.howell@msnyuhealth.org
Hebert
Paul
P
Chatterjee
Samprit
S
Kleinman
Lawrence C
LC
Chassin
Mark R
MR
D001741:Black or African American / Q000706:statistics & numerical data*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006786:Hospitals, Urban; D006801:Humans; D007226:Infant Mortality / Q000208:ethnology*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D009519:New York City / Q000453:epidemiology; D011336:Probability; D012042:Registries; D018570:Risk Assessment; D014505:Urban Population; D044465:White People / Q000706:statistics & numerical data*