摘要：Objective. We investigated whether the proportion of Black very low-birth-weight (VLBW) infants treated by hospitals is associated with neonatal mortality for Black and White VLBW infants. Methods. We analyzed medical records linked to secondary data sources for 74050 Black and White VLBW infants (501 g to 1500 g) treated by 332 hospitals participating in the Vermont Oxford Network from 1995 to 2000. Hospitals where more than 35% of VLBW infants treated were Black were defined as “minority-serving.” Results. Compared with hospitals where less than 15% of the VLBW infants were Black, minority-serving hospitals had significantly higher risk-adjusted neonatal mortality rates (White infants: odds ratio [OR]=1.30, 95% confidence interval [CI] = 1.09, 1.56; Black infants: OR = 1.29, 95% CI = 1.01, 1.64; Pooled: OR = 1.28, 95% CI=1.10, 1.50). Higher neonatal mortality in minority-serving hospitals was not explained by either hospital or treatment variables. Conclusions. Minority-serving hospitals may provide lower quality of care to VLBW infants compared with other hospitals. Because VLBW Black infants are disproportionately treated by minority-serving hospitals, higher neonatal mortality rates at these hospitals may contribute to racial disparities in infant mortality in the United States. Neonatal mortality in the United States fell from 28.8 deaths per 1000 live births in 1940 to 4.6 deaths per 1000 live births in 2000. 1 Yet despite this tremendous gain in infant survival, racial and ethnic disparities in neonatal mortality have persisted or even increased over time. In Black and White infants, the disparity in neonatal mortality, defined as mortality in the first 28 days of life, has actually increased in recent years from twice as high for Black infants compared with White infants in 1980, to two-and-one-half times as high for Black infants in 2000. 1 , 2 This and other disparities in mortality are a major health policy concern and led the president of the United States to identify infant mortality as 1 of 6 areas to be targeted to reduce racial disparities in health in the United States. Previous studies have identified several hospital characteristics associated with health outcomes for infants. One study found that infants born in hospitals with large-volume tertiary neonatal intensive care units (NICUs) had the most favorable mortality rates. 3 In another study, low-birthweight infants (<2000 grams) born in hospitals without NICUs or with small or intermediate NICUs had significantly higher mortality compared with infants born in hospitals with regional NICUs. 4 In a recent study, very low-birthweight (VLBW) infants born in hospitals with higher volume NICUs had lower mortality than VLBW infants born in hospitals with lower volume NICUs. 5 Finally, previous studies have found that lower staff-to-infant ratios and higher staff workload levels are associated with higher mortality rates among very low-birthweight infants. 3 , 6 , 7 Studies of adult patients have also identified hospital characteristics associated with health outcomes. These include whether a hospital is located in an urban setting, a hospital’s profit status, whether a hospital is a teaching institution, the number of patients treated, and the institution’s financial status. 8 – 13 Adult studies have also found that health outcomes vary by the patient population a hospital serves. For example, 1 study of adult patients discharged from 51 randomly selected hospitals in New York found that hospitals primarily serving minority patients had significantly more negligent adverse events (defined as injuries caused by medical treatment) than non–minority-serving hospitals. 14 Another study found that hospitalized Black Medicare patients were more likely than their White counterparts to receive lower quality of care. 15 No similar studies have examined the association between the racial and ethnic makeup of the infants treated by hospitals and their health outcomes. To help address this gap, we investigated whether the proportion of minority infants treated by hospitals is associated with neonatal mortality in a high-risk population of VLBW infants. In the United States, mortality among VLBW infants accounts for more than half of all infant deaths. 1 To the extent that we found mortality differences by the proportion of minority infants treated by hospitals, we investigated whether these differences were explained by other hospital characteristics such as patient volume, level of care at the hospital, or differences in the use of effective treatments.
