P0754 - Racial/ethnic differences in the prevalence of medical complexity or death among a national cohort of VLBW infants

Background
With advances in obstetrical and neonatal care, very low birthweight (VLBW, 1 year and involving several organ systems or 1 system severely enough to require specialty care and hospitalization, and/or reliance on a medical technology or device (technology dependence; (TD)). Racial/ethnic differences in the prevalence of CCC or TD in VLBW infants are not known. Thus, we sought to estimate the racial/ethnic difference in the prevalence of CCC/TD or death among U.S. born VLBW infants.

Methods
We performed a retrospective, cross-sectional analysis of 2009 and 2012 discharge data from the Healthcare Cost and Utilization Project’s Kids’ Inpatient Database (KID), including all VLBW infants and excluding infants with missing demographics. The main outcome was having CCC, TD, or death (CCC/TD/death). Multiple logistic regression was used to model the association of several factors with CCC/TD/death, stratified by race/ethnicity (non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and other), adjusting for patient-, hospital-, and clinical-level factors.

Results
Our cohort included 58,597 VLBW infants. Adjusted odds ratios for CCC/TD/death for various characteristics, stratified by race/ethnicity, are shown in Table 1. Compared to NHB infants with private insurance, NHB infants with public insurance had decreased odds of having CCC/TD/death. Compared to Hispanic infants in the Northeast (NE), Hispanic infants in the Midwest (MW) and South (S) had increased odds of CCC/TD/death. Infants of other races in the South also had increased odds of CCC/TD/death compared to those in the NE. Infants of all races/ethnicity groups had higher odds of CCC/TD/death if they had an operative procedure, were outborn, or were <500g or 500-999g compared to 1000-1499g. Notably, NHB infants <500g had 63.6x the odds of CCC/TD/death compared to those 1000-1499g (95% CI 48.8-81.2).

Conclusions
Demographic characteristics, including insurance and region, were associated with increased prevalence of CCC/TD/death in certain racial/ethnic groups. Additionally, NHB infants <500g had over 63 times the odds of CCC/TD/death compared to those 1000-1499g, whereas infants <500g of all other race groups had only between 24 and 37 times higher odds. The drivers for these differences are not clearly understood and warrant further investigation.