Perinatal & Pediatric
Mediation of the racial disparity in Neonatal Hypoxic Ischemic Encephalopathy (HIE) by socioeconomic position (SEP) in the HCUP KID Database Hailey Jaschob* Hailey Jaschob Keith A. Dookeran James Groh Janine Y. Khan
HIE may be more common among Black compared to White newborns in the U.S. We hypothesize that this disparity is mediated by SEP factors. Cross-sectional HCUP KID data from 2016, 2019, and 2022 was used to examine weighted prevalence of HIE and Therapeutic Hypothermia (TH) among neonates 35 weeks gestational age. We estimated Black/White HIE and TH risk differences (RDs and 95% CIs) reported as cases per 1000, using multivariable generalized linear models adjusting for year, sex, hospital size and region. We also estimated average controlled direct associations (ACDA) to evaluate the adjusted prevalence difference for HIE by race and performed a series of ACDA controlling for SEP factors [payer (Medicaid/Private), and income (ecologic quartiles)] using the Baron and Kenny method for mediation analysis. Overall weighted record counts were White, 510,745, and Black, 154,984. Compared to Whites, Blacks were more likely to be on Medicaid (36% vs 73%) and have lowest ecologic income quartile (20% vs 47%). Overall weighted HIE prevalence was 4.06 and increased with each cycle (2016=3.17; 2019=4.01; 2022=4.95). Overall weighted TH prevalence was 1.00 and increased with each cycle (2016=0.70, 2019=1.04, 2022=1.25). Crude models showed a significant increase in HIE among Blacks compared to White (1.31; 0.82, 1.80). Crude models for TH revealed a significant reduction in application among Blacks compared to Whites with HIE (-0.05; -0.09, -0.12). In fully adjusted models, compared with Whites, Blacks had a significant 1.11 (0.61, 1.62) increase in HIE. The racial disparity in HIE reduced by 39% to a value of 0.68 (0.09, 1.27) after additionally adjusting for SEP factors, and payer type accounted for most of the mediated effect (87%). Our findings suggest that observed racial differences in HIE prevalence are, at least partially, mediated by differences in SEP, which are likely upstream factors that affect prenatal health. Application of TH in newborns with HIE differs by race.