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Leo S. Morales, MD, PhD, Douglas Staiger, PhD, Jeffrey D. Horbar, MD, Joseph Carpenter, MS, Michael Kenny, MA, Jeffrey Geppert, MA and Jeannette Rogowski, PhD

Leo S. Morales is with the University of California, Los Angeles and the RAND Corporation, Santa Monica, Calif. Douglas Staiger is with Dartmouth College, Hanover, NH, and the National Bureau of Economic Research, Cambridge, Mass. Jeffrey D. Horbar is with the University of Vermont and the Vermont Oxford Network, both in Burlington. Joseph Carpenter is with the Vermont Oxford Network. Michael Kenny is with the University of Vermont. Jeffrey Geppert is with the National Bureau of Economic Research. Jeannette Rogowski is with the University of Medicine and Dentistry of New Jersey.

Correspondence: Requests for reprints should be sent to Leo S. Morales, MD, PhD, 911 Broxton Avenue, Los Angeles, CA 90024 (e-mail: morales{at}rand.org).

Objective. We investigated whether the proportion of Black very low-birth-weight (VLBW) infants treated by hospitals is associated with neonatal mortality for Black and White VLBW infants.

Methods. We analyzed medical records linked to secondary data sources for 74050 Black and White VLBW infants (501 g to 1500 g) treated by 332 hospitals participating in the Vermont Oxford Network from 1995 to 2000. Hospitals where more than 35% of VLBW infants treated were Black were defined as "minority-serving."

Results. Compared with hospitals where less than 15% of the VLBW infants were Black, minority-serving hospitals had significantly higher risk-adjusted neonatal mortality rates (White infants: odds ratio [OR]=1.30, 95% confidence interval [CI] = 1.09, 1.56; Black infants: OR = 1.29, 95% CI = 1.01, 1.64; Pooled: OR = 1.28, 95% CI=1.10, 1.50). Higher neonatal mortality in minority-serving hospitals was not explained by either hospital or treatment variables.

Conclusions. Minority-serving hospitals may provide lower quality of care to VLBW infants compared with other hospitals. Because VLBW Black infants are disproportionately treated by minority-serving hospitals, higher neonatal mortality rates at these hospitals may contribute to racial disparities in infant mortality in the United States.

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