title: The differential effects of maternal age, race/ethnicity and insurance on neonatal intensive care unit admission rates.
abstract: BACKGROUND
  Maternal race/ethnicity, age, and socioeconomic status (SES) are important factors determining birth outcome. Previous studies have demonstrated that, teenagers, and mothers with advanced maternal age (AMA), and Black/Non-Hispanic race/ethnicity can independently increase the risk for a poor pregnancy outcome. Similarly, public insurance has been associated with suboptimal health outcomes. The interaction and impact on the risk of a pregnancy resulting in a NICU admission has not been studied. Our aim was, to analyze the simultaneous interactions of teen/advanced maternal age (AMA), race/ethnicity and socioeconomic status on the odds of NICU admission.
  
  
  METHODS
  The Consortium of Safe Labor Database (subset of n = 167,160 live births) was used to determine NICU admission and maternal factors: age, race/ethnicity, insurance, previous c-section, and gestational age.
  
  
  RESULTS
  AMA mothers were more likely than teenaged mothers to have a pregnancy result in a NICU admission. Black/Non-Hispanic mothers with private insurance had increased odds for NICU admission. This is in contrast to the lower odds of NICU admission seen with Hispanic and White/Non-Hispanic pregnancies with private insurance.
  
  
  CONCLUSIONS
  Private insurance is protective against a pregnancy resulting in a NICU admission for Hispanic and White/Non-Hispanic mothers, but not for Black/Non-Hispanic mothers. The health disparity seen between Black and White/Non-Hispanics for the risk of NICU admission is most evident among pregnancies covered by private insurance. These study findings demonstrate that adverse pregnancy outcomes are mitigated differently across race, maternal age, and insurance status.
authors.affiliation: Department of Neonatal-Perinatal Medicine, St, Christopher's Hospital for Children, Philadelphia, PA, USA. bedejongh@gmail.com
authors.forename: Beatriz E
authors.initials: BE
authors.lastname: de Jongh
authors.forename: Robert
authors.initials: R
authors.lastname: Locke
authors.forename: David A
authors.initials: DA
authors.lastname: Paul
authors.forename: Matthew
authors.initials: M
authors.lastname: Hoffman
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D005260:Female; D005865:Gestational Age; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D012923:Social Class; D055815:Young Adult