Examining racial disparities in unexpected newborn complications


Racial disparities abound in health care. How do they impact neonatal morbidity?

Research over the past several years has shown that a variety of health outcomes vary by race or ethnicity, which has led to government agencies declaring that institutional racism is a public health crisis. A report on neonatal morbidity elucidates the differences noted between White infants and their non-White counterparts.1

Investigators used birth certificate and discharge abstract data from 40 New York City hospitals from 2010–2014. Newborns were included if they were born at term, singleton, had a birth weight ≥2500 g, and were without preexisting fetal conditions. Morbidity was classified using The Joint Commission’s unexpected newborn complications metric. Multivariable logistic regression was used to compare the morbidity risk among ethnic and racial groups. Risk-standardized complication rates were created for each hospital to examine quality and allow for ranking, as well as assessing the differences in the racial and ethnic distribution of births across the facilities.

Among the 483,834 low-risk infants, the unexpected complications rate was 48.0 per 1000 births. Following adjustment for patient characteristics, investigators found that the risk of morbidity was higher among Black and Hispanic infants than White infants (odds ratio: 1.5 [95% CI 1.3–1.9]; odds ratio: 1.2 [95% CI 1.1–1.4], respectively). Among the 40 hospitals included in the sample, the risk-standardized complications varied from 25.3 to 162.8 per 1000 births. One in 3 Black and Hispanic women delivered their child in a hospital that ranked in the highest morbidity category. By comparison, 1 in 10 White and Asian American women delivered in a hospital in that category (P < .001).

The investigators concluded that Black and Hispanic women were far more likely to deliver a child in a hospital that had high complication rates than women who were White or Asian American. They noted that the results of their study connect hospital quality with newborn health disparities that are preventable. The creation of quality improvement programs that address routine obstetric and neonatal care in hospitals is paramount to achieving equity in perinatal outcomes for Black and Hispanic outcomes.


1. Glazer K, Zeitlin J, Egorova N, et al. hospital quality of care and racial and ethnic disparities in unexpected newborn complications. Pediatrics. August 24, 2021. Epub ahead of print. doi:10.1542/peds.2020-024091

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