Racial variability in the treatment and survival of neonates with gastroschisis

Abstract

Introduction: The purpose of this study was to determine what factors impact the quality of care provided to neonates born with gastroschisis in the United States. Methods: The Kids’ Inpatient Database (KID) was queried to identify all patients with gastroschisis born during 1997 and 2000. The KID database was compiled by the Agency for Healthcare Research and Quality, and for 1997 includes 1.9 million discharge records from 2,521 hospitals in 22 states and 2000 includes 2.5 million discharge records from 2,784 hospitals in 27 states. Data collected for each patient includes gender, race, insurance type, hospital teaching status, time from admission to first procedure, length of stay (LOS), total hospital charges, and inpatient mortality. Comparisons between groups were made using logistic regression or multivariate regression as appropriate. Results: We identified 2,131 cases of gastroschisis. Most patients were cared for at teaching hospitals (n=1168, 90%), insured by Medicaid (Medicaid=61%, Private=32%, self-pay/other=7%), and Caucasian (white=54%, Hispanic=26%, black=10%). Overall, neonates waited 1.3±.2 days for their first surgical procedure, had a mean LOS of 41±.9 days, and accrued $116,233±3602 in total hospital charges. Mean inpatient mortality was 4% (n=85). Regression models that controlled for gender, insurance status, income level, and geography demonstrated that African American and Hispanic neonates waited longer for initial surgical repair of their abdominal wall defects (black=3.3, Hispanic=2.2, white=1.2 days, p<.05), and Hispanics had significantly higher in-hospital mortality (OR=2.83, 1.24-6.39). Conclusion: Hispanic and African American neonates born with gastroschisis had longer times to surgical treatment, and Hispanics have higher mortality.