Hospitals Play Significant Role in Racial Disparities for Premature Babies in NYC

Premature babies face a host of dangers. Born before 37 weeks, they often have underdeveloped organs and an increased susceptibility to infection. But some preemies are at even greater risk, simply because of where they’re born.

A new study from Mount Sinai found that children born at certain New York City hospitals are at significantly greater risk for death or severe complications that can leave them with lifelong disabilities. And those children tend to be black or Hispanic.

Researchers studied more than 7,000 preterm births at 39 New York City hospitals over four years. They found that black and Hispanic mothers deliver in hospitals with higher rates of severe complications and death for premature children. That leads to poorer outcomes for their babies.

In fact, the study found that the hospital a baby is born in accounts for 40 percent of the difference in outcomes between black and white babies. And it accounts for nearly a third of the difference between Hispanic and white babies. Simply put: hospitals play a big role in driving racial disparities in premature infant outcomes.

In New York City, premature black and Puerto Rican babies die at twice the rate of their white counterparts. Even those who survive can experience severe complications, leaving them with developmental delays and mental health problems. “These early disparities set a trajectory for later life,” the authors of the study wrote. Health differences at birth can persist and be amplified overtime, perpetuating socioeconomic disparities. So black and Hispanic babies that get off to a difficult start in the hospital can pay for it the rest of their lives.

Previous research has focused on infant factors like gestational age and birthweight as causes for the disparity in outcomes for premature babies. The Mount Sinai study explored hospitals as another contributing factor.

“We found infant factors were the biggest contributor to disparity,” said Dr. Elizabeth Howell, a co-author on the study and director of the Women's Health Institute at Mount Sinai's Icahn School of Medicine. “But hospital of birth was the second factor.”

Researchers found the risk of severe complications for premature babies varied widely by hospital. Some hospitals had risk rates of about 10 percent, while others were as high as 57 percent.

They don’t know what’s behind that variation. Howell said it could be anything from quality of care to the use of evidence-based practices. She added that it’s an important area for future research.

The study didn’t name specific hospitals, but researchers noted that improving outcomes at the lowest performing hospitals — which serve the most black and Hispanic women — should be a priority.

“We can do things to improve quality, so therefore, we should be able to reduce disparities,” Howell said.