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Neonatal mortality and disparities within the military health system

Journal of Perinatology volume 43, pages 496–502 (2023)Cite this article

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Abstract

Introduction

Racial disparity exists in U.S. neonatal mortality; Black, non-Hispanic neonates are at higher risk of death. We aim to examine overall and race-specific neonatal mortality within the Military Health System (MHS).

Methods

Retrospective cohort study of infants delivered within the MHS between 2013–2015. Variables were extracted from the Military Health System Data Repository.

Results

There were 320,283 live births within the MHS from 2013–2015; 588 neonates died, a death rate of 1.84/1000. Cohort neonatal mortality and incidence of preterm delivery (7.2%) were lower than concurrent U.S. statistics. Black, non-Hispanic neonates had a 2-fold increased risk of death (OR: 2.11; 95% CI 1.73–2.56, p < 0.001) over White, non-Hispanic neonates. Officer versus enlisted rank conferred no difference in neonatal mortality (OR: 0.88; 95% CI 0.74–1.03).

Conclusion

Neonatal mortality within the MHS is lower than in the U.S. Despite universal insurance coverage and access to care, racial disparity persists. Risk of death is not modified by socioeconomic status. These findings highlight the need for critical examination of healthcare equity within neonatal-perinatal medicine.

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Fig. 1: CONSORT diagram of study population.
Fig. 2: Neonatal mortality rate by parental race and Hispanic origin, NVSS vs. MHS.

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Data availability

Available upon request

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Acknowledgements

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA

    Rasheda J. Vereen & Matthew Nestander

  2. Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Gayle Haischer-Rollo & Caitlin M. Drumm

  3. Research Division, Graduate Medical Education, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA

    James K. Aden

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  1. Rasheda J. Vereen
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  5. Caitlin M. Drumm
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Contributions

RJV designed the study, participated in analysis, contributed to manuscript creation and revision; MN participated in analysis, contributed to manuscript creation and revision; GHR designed the study, participated in analysis, contributed to manuscript creation and revision; JKA designed the study, performed statistical analysis, contributed to manuscript creation and revision; CMD designed the study, participated in analysis, contributed to manuscript creation and revision.

Corresponding author

Correspondence to Caitlin M. Drumm.

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Competing interests

The authors declare no competing interests.

Ethical approval

The study was deemed exempt by the Brooke Army Medical Center Institutional Review Board (reference number C.2019.096n).

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Vereen, R.J., Nestander, M., Haischer-Rollo, G. et al. Neonatal mortality and disparities within the military health system. J Perinatol 43, 496–502 (2023). https://doi.org/10.1038/s41372-022-01598-w

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  • DOI: https://doi.org/10.1038/s41372-022-01598-w

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