Racial and Economic Neighborhood Segregation, Site of Delivery, and Very Preterm Neonatal Morbidity and Mortality.

OBJECTIVE To assess the influence of racial and economic residential segregation of home or hospital neighborhood on very preterm birth morbidity and mortality. STUDY DESIGN We constructed a retrospective cohort of n=6461 infants born <32 weeks using 2010-2014 New York City vital statistics-hospital data. We calculated racial and economic Index of Concentration at the Extremes (ICE) for home and hospital neighborhoods. Neonatal mortality and morbidity was death and/or severe neonatal morbidity. We estimated relative risks for ICE measures and NMM using log binomial regression, and the risk-adjusted contribution of delivery hospital using Fairlie decomposition. RESULTS Infants whose mothers live in neighborhoods with the highest relative concentration of Black residents had a 1.6 times higher risk of NMM than those with the highest relative concentration of White residents (95% Confidence Interval=1.2, 2.1). Delivery hospital explained over half of neighborhood differences. Infants with both home and hospital in high-concentration Black neighborhoods had a 38% adjusted risk of NMM, compared with 25% of those with both home and hospital high-concentration White neighborhoods (P = .045). CONCLUSIONS Structural racism influences very preterm birth NMM through both the home and hospital neighborhood. Quality improvement interventions should incorporate a framework that includes neighborhood context.