Black, Hispanic, and Asian very preterm and very low birthweight infants are segregated across neonatal intensive care units (NICUs) in the United States, reflecting the uneven distribution of minority populations. However, even taking geographic differences in NICU quality into account, Asian infants received care at higher-quality NICUs than white infants, and black infants received care at lower-quality NICUs than white infants, according to a study published in JAMA Pediatrics.

In the United States, racial and ethnic minority patients receive lower-quality health care than white non-Hispanic patients. This cohort study of 743 NICUs within the Vermont Oxford Network analyzed data on 117,982 black, Hispanic, Asian, and white infants born at 22 to 29 weeks’ gestation or 401 g to 1500 g between January 2014 and December 2016 to evaluate differences in healthcare quality for very preterm and very low birthweight infants.

The infants in the study (36,359 black [31%], 21,808 Hispanic [18%], 5920 Asian [5%], and 53,895 white [46%]) were segregated among the 743 NICUs by ethnicity and race, with a NICU segregation index of 0.50 for black infants (95% CI, 0.46-0.53), 0.58 for Hispanic  infants (95% CI, 0.54-0.61), and 0.45 for Asian infants (95% CI, 0.40-0.50). Black infants received care at NICUs with lower quality scores, and Hispanic and Asian infants received care at NICUs with higher quality scores, with a NICU inequality index of 0.07 for black infants (95% CI, 0.02-0.13), -0.10 for Hispanic infants (95% CI, -0.17 to -0.04), and -0.26 for Asian infants (95% CI, -0.32 to -0.19), with a marked variation in weighted mean NICU quality scores among the census regions (range -0.69 to 0.85). Geographic region of residence explained the inequality for Hispanic infants but not for black or Asian infants.

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The study investigators concluded, “Even after accounting for differences in NICU quality among geographic regions, Asian infants received care at higher-quality NICUs and black infants at lower-quality NICUs than white infants. Explaining these patterns will require understanding the effects of sociodemographic factors and public policy on hospital quality, access, and choice for minority women and their infants.”


Horbar JD, Edwards EM, Greenberg LT, et al. Racial segregation and inequality in the neonatal intensive care unit for very low-birth-weight and very preterm infants [published online March 25, 2019]. JAMA Pediatr. doi: 10.1001/jamapediatrics.2019.0241