Racial Differences in the Use of Respiratory Medications in Premature Infants after Discharge from the Neonatal Intensive Care Unit

Objective

To determine the effect of race and ethnicity on the use of oral beta-agonists, inhaled beta-agonists, and inhaled corticosteroids to treat respiratory symptoms in former premature infants after controlling for medical conditions, socioeconomic status, and site of outpatient care.

Study design

Using a population cohort of infants born at a gestational age ≤34 weeks at 5 Northern California Kaiser Permanente hospitals between 1998 and 2001 (n = 1436), we constructed multivariable models to determine predictive factors for the receipt of respiratory medications during the first year after discharge.

Results

After controlling for confounding factors, black infants were more likely to receive oral beta-agonists compared with white infants (OR 4.30, 95% CI 2.33-7.94), and Hispanic infants were less likely to receive inhaled beta-agonists (OR 0.62, 95% CI 0.39-0.99) or inhaled corticosteroids (OR 0.28, 95% CI 0.12-0.67). These findings were not explained by more outpatient visits for respiratory symptoms in black or Hispanic infants, because the observed racial differences persisted when children of similar respiratory symptoms were examined.

Conclusions

Even in a high-risk population of insured infants, substantial racial differences persist in the use of respiratory medications that could not be explained by differences in respiratory symptoms.

Abbreviations: BPD, Bronchopulmonary dysplasia, CMIS, Cost Management Information System, GA, Gestational age, IFS, Infant Function Status Study, IVH, Intraventricular hemorrhage, KPMCP, Kaiser Permanente Medical Care Program, NEC, Necrotizing enterocolitis, NMDS, Neonatal Minimal Data Set, NICU, Neonatal intensive care unit, ROP, Retinopathy of prematurity