58 - Health system variability and neonatal mortality

Publication Number: 4057.58

Tahmina Ahmad, Avalere Health, Alexandria, VA, United States; Hatem Eltaly, Cleveland Clinic Children’s, Cleveland, OH, United States; Aysuna Galandarova Ibrahimli, Cleveland Clinic Children's, Saint Louis, MO, United States; Alshimaa Abdalla, Cleveland Clinic Children's, Cleveland, OH, United States; HANY ALY, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Mohamed A. Mohamed, Cleveland, Cleveland, OH, United States

Background: Neonatal mortality shows significant variation across hospitals, influenced by factors such as hospital size, location, teaching status, and insurance coverage, reflecting persistent disparities in care quality.

Objective: To examine the association of inpatient neonatal mortality with variability in healthcare services factors such as hospital size, urban/rural designation, teaching/non-teaching status, regional location and insurance coverage.

Design/Methods: This is a pooled, cross-sectional analysis of the National Inpatient Sample (2016-2020). Information on neonatal demographics, clinical conditions, and neonatal outcomes at discharge was identified using respective ICD10-CM codes. Bivariate and multivariate analyses using logistic regression models were used to describe neonatal characteristics and to calculate the risk of mortality with each independent variable.

Results: The weighted sample included 18,916,435 hospital records for infants admitted to hospital at ≤28 days of life where 99.7% were > 24 weeks Gestational Age at birth, 46.6% of them were Caucasians, and 51.4% of them were females. Neonatal death during hospitalization occurred in 42,245 cases (2.3/1,000 live birth). Infants with congenital lung malformations, chromosomal abnormalities, pulmonary hemorrhage, renal failure, abdominal wound dehiscence or seizures were 44.2, 14.5, 8.5, 8.3, 8.1, and 7.9 times more likely to suffer inpatient neonatal mortality. Compared to small-sized hospitals, medical care at medium or large size hospitals was associated with higher mortality, adjusted odds ratios (aOR)= 1.3, 95% CI:(1.1-1.3), and 1.5 (1.4-1.6), respectively. Adjusted OR for inpatient neonatal mortality in urban non-teaching or urban teaching compared to rural hospitals were 1.3 (1.1-1.3) and 2.0 (1.8-2.0), respectively. Infants in the South region had higher neonatal mortality outcomes compared to Northeast, aOR= 1.4 (1.3-1.4). Infants with public insurance coverage or no insurance coverage experienced higher inpatient neonatal mortality compared to those with private insurance, aOR= 1.4 (1.2-1.4) and 2.3 (2.1-2.3), respectively (Table 1).

Conclusion(s): Neonatal inpatient mortality was higher in larger and urban teaching hospitals, in the South region, and among infants with public or no insurance coverage. These associations may partly reflect selection bias, as sicker neonates are more likely to be delivered or transferred to higher-level centers. Nonetheless, the findings highlight ongoing disparities in neonatal outcomes and the need for strategies that ensure equitable access to high-quality care across all hospital settings.

Table 1.
Inpatient neonatal mortality by health system related factors