TY - JOUR
T1 - Racial and Ethnic Inequities in Therapeutic Hypothermia and Neonatal Hypoxic–Ischemic Encephalopathy
T2 - A Retrospective Cohort Study
AU - Fall, Carolyn
AU - Baer, Rebecca J.
AU - Jelliffe-Pawlowski, Laura
AU - Matoba, Nana
AU - Lee, Henry C.
AU - Chambers, Christina D.
AU - Bandoli, Gretchen
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/6
Y1 - 2024/6
N2 - Objective: To investigate racial inequities in the use of therapeutic hypothermia (TH) and outcomes in infants with hypoxic–ischemic encephalopathy (HIE). Study design: We queried an administrative birth cohort of mother–baby pairs in California from 2010 through 2019 using International Classification of Diseases codes to evaluate the association between race and ethnicity and the application of TH in infants with HIE. We identified 4779 infants with HIE. Log-linear regression was used to calculate risk ratios (RR) for TH, adjusting for hospital transfer, rural location, gestational age between 35 and 37 weeks, and HIE severity. Risk of adverse infant outcome was calculated by race and ethnicity and stratified by TH. Results: From our identified cohort, 1338 (28.0%) neonates underwent TH. White infants were used as the reference sample, and 410 (28.4%) received TH. Black infants were significantly less likely to receive TH with 74 (20.0%) with an adjusted risk ratio (aRR) of 0.7 (95% CI 0.5-0.9). Black infants with any HIE who did not receive TH were more likely to have a hospital readmission (aRR 1.36, 95% CI 1.10-1.68) and a tracheostomy (aRR 3.07, 95% CI 1.19-7.97). Black infants with moderate/severe HIE who did not receive TH were more likely to have cerebral palsy (aRR 2.72, 95% CI 1.07-6.91). Conclusions: In this study cohort, Black infants with HIE were significantly less likely to receive TH. Black infants also had significantly increased risk of some adverse outcomes of HIE. Possible reasons for this inequity include systemic barriers to care and systemic bias.
AB - Objective: To investigate racial inequities in the use of therapeutic hypothermia (TH) and outcomes in infants with hypoxic–ischemic encephalopathy (HIE). Study design: We queried an administrative birth cohort of mother–baby pairs in California from 2010 through 2019 using International Classification of Diseases codes to evaluate the association between race and ethnicity and the application of TH in infants with HIE. We identified 4779 infants with HIE. Log-linear regression was used to calculate risk ratios (RR) for TH, adjusting for hospital transfer, rural location, gestational age between 35 and 37 weeks, and HIE severity. Risk of adverse infant outcome was calculated by race and ethnicity and stratified by TH. Results: From our identified cohort, 1338 (28.0%) neonates underwent TH. White infants were used as the reference sample, and 410 (28.4%) received TH. Black infants were significantly less likely to receive TH with 74 (20.0%) with an adjusted risk ratio (aRR) of 0.7 (95% CI 0.5-0.9). Black infants with any HIE who did not receive TH were more likely to have a hospital readmission (aRR 1.36, 95% CI 1.10-1.68) and a tracheostomy (aRR 3.07, 95% CI 1.19-7.97). Black infants with moderate/severe HIE who did not receive TH were more likely to have cerebral palsy (aRR 2.72, 95% CI 1.07-6.91). Conclusions: In this study cohort, Black infants with HIE were significantly less likely to receive TH. Black infants also had significantly increased risk of some adverse outcomes of HIE. Possible reasons for this inequity include systemic barriers to care and systemic bias.
KW - bias
KW - structural racism
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U2 - 10.1016/j.jpeds.2024.113966
DO - 10.1016/j.jpeds.2024.113966
M3 - Article
C2 - 38369239
AN - SCOPUS:85188011115
SN - 0022-3476
VL - 269
JO - Journal of Pediatrics
JF - Journal of Pediatrics
M1 - 113966
ER -