Research has long suggested that the quality of health care in the United States differs depending on a patient’s race. A new study suggests that gap affects even the youngest of patients, newborns in California’s Neo-Natal Intensive Care Units.
The authors of the study, published in the journal Pediatrics, found that white and Asian American newborns received a better quality of care than African American and Latino newborns.
The study analyzed data from 18,616 low birthweight (between 14 ounces and 3.3 pounds) infants delivered and treated at 134 California hospitals between 2010 to 2014. Researchers examined nine specific treatments and processes. Infants who died shortly after delivery or who were born with congenital defects were excluded from the study.
The data was furnished by the California Perinatal Quality Care Collaborative, a group of neonatologists and non-profit organizations that assemble data and perform research on prenatal care. About 90 percent of the hospitals in California with a Neo-Natal Intensive Care Units (NICU) provide data to the collaborative, covering about 95 percent of all low-weight births statewide. Altogether, about 8,200 Latino, 5,000 white, 2,500 African American and 2,350 Asian American infants were part of the study.
Researchers found that the white infants were less likely than blacks to suffer hypothermia, more likely to receive antenatal steroids and a timely eye exam, less likely to contract hospital-acquired infections, and significantly more likely to be have a supply of breast milk for feeding upon discharge.
There were similar though less pronounced gaps between white and Latino newborns.
Little difference was found between the care received by Asian American and white newborns, although the former tended to do better whether they were treated in a higher or lower-performing NICU.
“There’s a long history of disparity in health care delivery, and our study shows that the NICU is really no different,” said Jochen Profit, associate professor of pediatrics at Stanford University and the study’s lead author.
Not all the data suggested minority infants received uniformly less care. African American infants were significantly more likely to grow rapidly while in the NICU than whites, and less likely than white infants to suffer from a collapsed lung.
Profit, while declining to identify specific hospitals, noted that many facilities serving low-income areas in the state often provide care to minority newborns that is equal to what white infants receive. “There are some hospitals that should perform quite poorly, but they don’t,” he said.
Overall, however, the study concluded that there was a large gap in overall performance between the highest and lowest-performing NICUs, and more minority infants were born at those hospitals delivering a lower quality of care. Researchers recommended that “targeted, culturally competent care (may be) highly effective in bridging the quality gap for these populations.”
Grim as the data might seem, Profit observes that it could be even worse in other states. “California hospitals as a group, actually provide better [NICU] care than most states in the country – even those performing on the lower end,” he said.