Study Examines Racial Differences in the Use of Respiratory Medications in Premature Infants After Discharge

December 10, 2007

"Racial and ethnic status was associated with different management of premature infants presenting with respiratory symptoms after discharge," state the authors of an article published in the December 2007 issue of the Journal of Pediatrics. Extreme prematurity often results in respiratory complications, and even moderate prematurity results in the need for supplemental oxygen during the first weeks after delivery. The article presents findings from a study to determine whether premature infants with respiratory symptoms are treated differently by racial or ethnic status, and to assess whether coexisting medical or socioeconomic factors or a higher incidence of respiratory symptoms explain these
differences, if differences exist.

The study sample was drawn from a large cohort of premature infants born between 1998 and 2001 at five Kaiser Permanente Medical Care Program (KPMCP) hospitals located in Northern California. The final sample included 1,436 infants born at a gestational age of 34 weeks or less. Use of oral beta-agonists, inhaled beta-agonists, and inhaled corticosteroids was identified from prescriptions filled during the first year after discharge from the neonatal intensive care unit. Outpatient and inpatient visits for respiratory symptoms were also
identified. Race and ethnicity were classified as Asian, black, Hispanic, white, or other/unknown on the basis of maternal information collected. Primary outpatient facility for each premature infant was also assigned. The analysis predicted the odds that infants with
different gestational ages and neonoatal complications would receive oral beta-agonists, inhaled beta-agonists, or inhaled corticosteroids by the infant's outpatient facility. Separate models were used to determine the use of a respiratory medication within targeted subgroups.

The authors found that:

  • After controlling for medical complications, other socioeconomic factors, and the location of outpatient care within the KPMCP system, black premature infants were four times more likely to receive oral beta-agonists and twice as likely to receive inhaled beta-agonists than infants in other racial and ethnic categories. Hispanic infants were less likely to receive inhaled medications than white infants.
  • After controlling for severity of respiratory symptoms experienced by infants within subgroups, as well as for the same medical and social factors included in previous models, black infants were still more likely to receive oral beta-agonists compared with white infants, and Hispanic infants had lower odds of receiving inhaled beta-agonists compared with white infants.

"These data suggest that, even in a high-risk population of infants, there are substantial racial differences in the management of respiratory disease that cannot be explained by differences in the severity, or prevalence, of respiratory symptoms," conclude the authors.


Lorch, S. A., Wade K. C., Bakewell-Sachs, S., Medoff-Cooper, B., Escobar, G. J. &  Silber, J. H. (2007). Racial Differences in the Use of Respiratory Medications in Premature Infants After Discharge From the Neonatal Intensive Care Unit. Journal of Pediatrics 151(6):635-641.

Abstract available here.


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