title: Cross-Sectional Analysis on Racial and Economic Disparities Affecting Mortality in Preterm Infants with Posthemorrhagic Hydrocephalus.
abstract: BACKGROUND
  Despite major advances in medicine, racial and socioeconomic disparities continue to affect health care outcomes. Higher overall infant mortality has been reported for black neonates compared with their Hispanic and white counterparts. The underlying basis for these differences remains unclear. A potential influencing factor is the management of premature neurologic complications in this disadvantaged group. This study examines racial and socioeconomic disparities on mortality in preterm infants with posthemorrhagic hydrocephalus (PHH).
  
  
  METHODS
  Data from the Nationwide Inpatient Sample and Kids Inpatient Database were combined from 2000 to 2010. Discharges with International Classification of Diseases, Ninth Revision, Clinical Modification codes for preterm births with intraventricular hemorrhage and PHH were included. Relative risk (RR) ratios for mortality, complications, length of stay, and hospital costs were obtained with multivariate analysis after controlling for patient-level, hospital-level, and admission-level factors.
  
  
  RESULTS
  When controlling for patient and hospital factors, black neonates had increased mortality compared with whites and Hispanics (RR = 1.47; P < 0.01). This association existed despite lower rates of congenital cardiac defects (RR = 0.84; P < 0.01), gastrointestinal complications (RR = 0.84; P < 0.01), and general complications of prematurity (RR = 0.95; P = 0.04) in the black cohort. Preterm infants insured by Medicaid had increased mortality compared with those with private insurance (RR = 1.2; P = 0.04) after adjusting for patient and hospital factors.
  
  
  CONCLUSIONS
  Among preterm infants with intraventricular hemorrhage and resultant PHH, black infants and those insured by Medicaid have significantly increased mortality but these 2 effects are independent. Further studies are needed to fully understand the factors affecting these racial and socioeconomic disparities.
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA. Electronic address: liweijin@usc.edu.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Jin
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Eisha A
authors.initials: EA
authors.lastname: Christian
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Attenello
authors.affiliation: Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Melamed
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Cen
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA; Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Krieger
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA; Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA.
authors.forename: J Gordon
authors.initials: JG
authors.lastname: McComb
authors.affiliation: Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Mack
mesh_terms: D015984:Causality; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D007223:Infant; D007226:Infant Mortality / Q000208:ethnology*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D044469:Racial Groups / Q000706:statistics & numerical data; D063505:Racism / Q000706:statistics & numerical data; D018570:Risk Assessment; D017678:Sex Distribution; D012959:Socioeconomic Factors; D015996:Survival Rate; D014481:United States / Q000208:ethnology
keywords: Hydrocephalus; Intraventricular hemorrhage; Kids Inpatient Database; Nationwide Inpatient Sample; Posthemorrhagic hydrocephalus; Preterm infant; Preterm neonate