69 - Racial and Ethnic Inequity Along the Early Intervention Care Cascade for Very Preterm Infants in Massachusetts

Publication Number: 3066.69

Yarden S. Fraiman, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States; Joanne F. Keith, Beth Israel Deaconess Medical Center, Boston, MA, United States; Ashley L. O'Donoghue, Harvard Medical School, Boston, MA, United States; Wanda D.. Barfield, Emory University School of Medicine, Tucker, GA, United States; Lindsay Rosenfeld, Boston University School of Social Work, Boston, MA, United States; Hafsatou Diop, Department of Public Health, Boston, MA, United States; Marie C. McCormick, Harvard TH Chan School of Public Health, Boca Rato, FL, United States; Jonathan S. Litt, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Very preterm infants (VPI; < 32 weeks gestational age) are at an increased risk for adverse cognitive, functional, and behavioral outcomes which makes them eligible for Early Intervention (EI) in Massachusetts (MA). EI is a federally-funded, state-operated home-based developmental service show to improve long-term outcomes for preterm infants. Accessing EI is complex and requires navigating the EI Care Cascade (EI-CC). Racial and ethnic inequities in EI participation have been documented but to reduce the inequity we must understand where and how inequities emerge along the EI-CC.

Objective: We conducted a longitudinal study using a large statewide population-based cohort of VPI to examine the EI-CC and potential inequities.

Design/Methods: Using the Pregnancy to Early Life Longitudinal database, we identified 7169 very preterm infants born between 1/1/2012-12/31/2019. The primary predictor was race and ethnicity as a proxy for racism. We modeled steps along the EI-CC [(1) referral, (2) evaluation, and (3) signed Individualized Family Service Plan [IFSP]) using sequential logistic regression models adjusted for (1) infant characteristics (sex, gestational age, birth weight), delivery characteristics (parity, AMA, multiple vs. singleton, infant medical variables (any comorbidities, any neonatal procedure, or no abnormalities), and (2) family social variables (maternal education level, maternal nativity, maternal marital status, language, and delivery hospitalization payor).

Results: Of 7169 infants, 84.0%, 71.3%, and 64.5% were referred, evaluated, and signed an IFSP respectively. Compared to non-Hispanic white (NHW) infants, minoritized infants were less likely to be referred, evaluated and receive an IFSP. Notably, NH Black (NHB) infants had a significantly lower odds of referral [OR 0.79 (95% CI 0.67-0.94)], evaluation [OR 0.41 (95% CI 0.34, 0.49)], and completing an IFSP [OR 0.68 (95% CI (0.53, 0.88)]. These effects were attenuated when adjusting for infant and family social variables. Inequities widened along the EI-CC. While 84.6% of NHW and 81.3% of NHB infants were referred to EI, only 55.0%, 64.2%%, and 62.1% of NHB, Hispanic, and Asian/Pacific Islander infants respectively had a signed IFSP compared to 68.4% of NHW infants.

Conclusion(s): Significant racial and ethnic inequities exist across the EI-CC. Small inequities identified at single points along the EI-CC may obscure how inequities grow over time. Efforts are needed to close the equity gap at each step of the care cascade.

Figure 1. Inequities Along the Early Intervention Care Cascade
Inequities along the Early Intervention Care Cascade (EI-CC) grow over time

Table 1. Demographics
Table 1_PAS EICC.pdfStudy population

Table 2. Multivariable modely of Early Intervention outcomes across the Early Intervention Care Cascade (EI-CC)
Table 2_PAS EICC_v2.pdf