Unexplained Disparity In Black Pre-Term Births

 ANN ARBOR, MI  -- The Center for Healthcare Research & Transformation (CHRT) based at the University of Michigan has released its Prematurity Issue Brief that shows pre-term births --- births at less than 37 weeks of gestation --- are the leading cause of health problems in infants and estimated to cost the U.S. more than $26 billion annually. In addition, the report shows that a black infant in Michigan is 70% more likely to be born prematurely than an infant of any other race.

"One in eight babies is born prematurely in the U.S. and Michigan with serious consequences for infant morbidity and mortality," said Marianne Udow-Phillips, director of CHRT.

"Premature infants are at high risk for respiratory problems and mortality and, are among the most significant cost drivers in health care. Yet, risk factors for preterm birth are complex and not fully understood including why black infants are more likely to be born prematurely than infants of other races."

Highlights of the Prematurity Issue Brief, a compilation of national and Blue Cross Blue Shield of Michigan (BCBSM) data, include:

• Late preterm births in Michigan, those between 34 and 37 weeks of gestation, increased by 20% from 1996 – 2006 while premature births, those less than 34 weeks gestation, remained stable. While nearly all of the increase in late preterm births was Cesarean section (C-section), available data do not show if these C-sections were medically indicated or elective.
• There is a significant disparity in the rate of premature births among blacks as compared to white, Asian and Hispanic populations. Black infants are 70 percent more likely to be born prematurely than white infants. Eleven percent of white and Hispanic infants and 9.9% of Asian infants are born prematurely, while almost 19 percent of black infants are born prematurely.  This contributes to disparities in infant mortality rates within these groups. Theory suggests that black mothers experience more stress during pregnancy than mothers of other races, leading to more premature births.
• Prematurity/low birth weight is the single largest cause of infant mortality in Michigan. Preterm infants born to black mothers are more likely to die in the perinatal period (after 22 weeks' gestation or within 7 days of birth) than those born to white mothers.
• Known risk factors for premature birth are history of preterm birth, being pregnant with multiple fetuses, use of in vitro fertilization even in singleton births, smoking, inadequate prenatal care, and being a relatively younger or older mother.
• The average charge per discharge for premature birth and low birth weight babies in Michigan was $102,103, approximately 14 times higher than the average charge per discharge of $7,182 for a healthy infant birth.
• Preterm births represent just 10.3% of BCBSM births in Michigan but comprise 52.6% of medical spending in the first year of life.  

"Prematurity is recognized as the single most important area in maternal child health where we need research to improve outcomes," said Timothy R. B. Johnson, M.D., professor and chair, Obstetrics & Gynecology Department, University of MichiganSchool of Medicine.  "The fact that there are profound disparities in the U.S. and in Michigan in the incidence and outcomes of prematurity makes attention to this topic even more critical."

The Prematurity Issue Brief is the fifth in a series examining the price of health care in Michigan.  While the report identifies important trends, costs and disparities, more research is needed to begin to understand the causes of premature birth.

"We don't know enough about the risk factors and causes of the rise in premature births. We can speculate about the impact of technology and fertility interventions but these births represent only a small percentage of total births. More study is needed so that we can improve outcomes, reduce disparities, and reduce the real and human cost of premature birth," says Udow-Phillips.

The Center for Healthcare Research & Transformation sponsors research and public information to promote evidence-based health care delivery, improve population health, and expand access to care. Housed at the University of Michigan, CHRT is a partnership between U-M and Blue Cross Blue Shield of Michigan to test the best ideas for improving the effectiveness and efficiency of the health care system.