Breast-milk feeding of very low birth weight infants as a function of hospital demographics

Abstract

Background/Objective:

Breast milk is the optimal nutrition in prematurity. African-American and Hispanic infants are less likely to receive breast milk.Our purpose was to investigate the extent to which hospital demographics, in terms of race and ethnicity, are associated with the likelihood of breast-milk feeding (BMF).

Subjects/Methods:

The California Perinatal Quality Care Collaborative (CPQCC) prospectively collected data on more than 90% of infants admitted into Californian neonatal intensive care units. Subjects had birth weight between 500 and 1500 g and were born at or transferred to a CPQCC center within 2 days of birth from 2006 to 2008. The primary outcome was any amount of BMF at the time of discharge. Hospitals were divided into quartiles by hospital percentage of each race, and BMF rates by race were compared. We created mixed logistic models for each race or ethnicity group to determine the marginal effect of hospital percentage of each race/ethnicity on feeding type at discharge, controlling for prenatal care, maternal age and birth weight as fixed effects and hospital of care as a random effect.

Result:

The state-wide BMF rate was 61%; rates were highest for Whites (68%), lower for Hispanics (59%) and lowest for Blacks (46%). BMF rates were higher for all race/ethnicity groups in hospitals with more White mothers. Differences were less pronounced for Hispanics than for Blacks. African Americans had the lowest rates of BMF when cared for in hospitals with more African Americans (43%) vs hospitals with fewer African Americans (59%, P=0.003). On the other hand, Whites had the lowest BMF rates (49%) in hospitals with the fewest Whites (Figure 1). With risk adjustment, Whites were more likely to engage in BMF when there were more Whites at that hospital (odds ratio 1.15 for 10% increase in Whites, 95% confidence interval 1.04, 1.28). Blacks were less likely to engage in BMF when more Blacks were at the hospital (odds ratio 0.80 for each 10% increase in Blacks, 95% confidence interval 0.67, 0.97). Hospital percentage of Hispanics did not contribute to Hispanic-feeding type.

Conclusion:

Hospitals serving more non-White patients were less likely to have premature infants fed breast milk for all races. Targeting such hospitals for quality improvement may help to improve BMF rates overall and reduce disparities.