Credit: Mount Sinai Health System
A new study by researchers with New York's Mount Sinai health system is shining a light on the role hospital quality can play in mortality and morbidity for "very preterm births," as well as racial disparities in the rate of VPTBs that seem to point the finger at where the baby is born.
"Black and Hispanic VPTB infants are more likely to be born at hospitals with higher risk-adjusted neonatal morbidity and mortality rates, and these differences contribute to excess morbidity and mortality among black and Hispanic infants," the authors wrote. "These early disparities set a trajectory for later life, as health differences in the short term can persist and be amplified over the long term."
A team of researchers led by Elizabeth Howell, MD, Director of the Women's Health Institute at the Icahn School of Medicine at Mount Sinai, examined data related to 7,177 very preterm births at 39 New York City hospitals. That means births that occurred at 24 to 31 weeks gestation.
Twenty-seven of the 39 hospitals were private, 33 had level 3 or 4 nurseries, and all were teaching hospitals, according to the study.
Researchers found that morbidity and mortality occurred in 28 percent of those births. They also found that it was higher among African-American and Hispanic VPTBs, with 32.2 percent of African-American VPTBs and 28.1 percent of Hispanic VPTBs experiencing severe complications and death as opposed to the 22.5 percent of white VPTBs that experienced it.
When researchers looked at the factors fueling this disparity, they found that the infant's health risk came first, but the hospital they are born in came a close second. The risk-standardized morbidity and mortality rate doubled for infants born in hospitals that had the highest rates of morbidity and mortality, and according to results, Black and Hispanic VPTB infants were more likely to be born in these hospitals.
Moreover, the study found that the hospital a VPTB baby is born in accounts for 40 percent of the disparity in outcomes between black and white babies and roughly 30 percent of the difference in outcomes for Hispanic and white babies. Specifically, 43.4 percent of Black infants, 34.4 percent of Hispanic VPTB babies and 22.9 percent of white VPTB infants were born in the highest morbidity and mortality category of hospitals.
In addition to a potential lifetime of challenges, these complicated births and infant mortality contribute to enormous costs for hospitals and patients.
The National Academy of Medicine (formerly the Institute of Medicine) has reported in the past that the cost associated with premature birth in the United States totals $26.2 billion each year, including $16.9 billion in medical and health care costs for the infant, $1.9 billion in labor and delivery fees for the mother, $611 million for early intervention services for children from birth to age 3 with disabilities and developmental delays, $1.1 billion for special education services for children with disabilities ages 3 through 21 and $5.7 billion in lost work and pay for people born prematurely.
Howell said that while New York City is unique, there are a number of large urban centers across the country and there are lessons to be learned from this study. While there was wide variation in the performances of the hospitals studies, there could be wide variation in care in other urban centers. No matter what, the costs to these morbidities are high both monetarily and in terms of life challenges. They also pose a great resource need for their surrounding communities.
"This makes us think about how those disparities manifest in morbidities as well as the possibility that quality of care can influence these outcomes. You're setting a trajectory of cost and extra resources for throughout that person's life," Howell said. "Quality of care is something that should be looked at at any hospital seeing high morbidity and mortality rates in these vulnerable patients, whether it's New York City hospitals or some other city."