336 - REALIZe disparities in regional infant mortality: a systematic, comprehensive assessment of recent trends

Poster Number: 336
Publication Number: 336.1101

Background: As the field of neonatal health equity shifts from disparity awareness to mitigation, neonatal intensive care units (NICUs) must account for the unique needs of local, diverse populations. While health disparities related to patient race, ethnicity, language, interpreter need, and zip code have been documented, these broad social and demographic factors are not regularly integrated in assessing NICU outcomes and care.

Objective: To compare recent, regional NICU trends of infant death prior to discharge by expanded REALIZe demographic characteristics: infant Race, Ethnicity, maternal Age, caregiver Language, Interpreter need, Zip code.

Design/Methods: We performed a retrospective study of all infants admitted to regional NICUs from January 1, 2015 to December 31, 2021. Data was sourced from national databases (Vermont Oxford Network, Children’s Hospital Neonatal Database) and electronic health records. We plotted the proportion of infant death prior to NICU discharge over time, by birthweight category and REALIZe characteristics. Logistic regression was used to estimate the odds ratio and 95% CI. Analyses were conducted using R.

Results: We studied 25,125 infants, 21.9% were Black, 69.3% White, and 8% Other race (Table 1). Overall, 8.5% of infants were very low birthweight and 6% extremely low birthweight (ELBW). Racial health disparities in birth weight mirrored national trends, with 9.3% Black patients being ELBW versus 5.0% White and 5.6% Other. Non-English language preference was documented in 6.0% and an interpreter need in 3.8%, potentially underreported compared to hospital averages. Mortality prior to discharge was 2.2% overall and 1.6x higher for Black infants (3.0%) compared to White (1.9%). Roughly 50% of our Black families lived in the local high-risk infant mortality rate (IMR) zip codes as identified by the local public health department, compared to 11.5% White and 25.2% Other families. Odds for mortality by REALIZe variables were higher in Black infants and families living in high-risk IMR zip codes (Table 2). REALIZe variables by weight subgroup were plotted overtime to observe longitudinal trends (Figure 1). We found no differences in mortality related to ethnicity, maternal age, language preference, or interpreter need.

Conclusion(s): Regional neonatal analysis found sustained, elevated mortality prior to NICU discharge in families with Black race and residence in a high-risk IMR zip code. Collection of accurate, complete demographic information is crucial to monitor multifaceted disparities and direct support and resources.