Disparity in access to perinatal tertiary care in a regionalized system

OBJECTIVE: If Race/ethnicity or socioeconomic status (SES) were a factor in the decision or timing of transfer of patients with high risk pregnancy to perinatal centers, then the racial composition of the group transferred would be different than in the group not transferred. STUDY DESIGN: Retrospective case/ control study of a large, urban Perinatal Center data set of all perinatal deaths less than 1500 grams in 2000, 2001, and 2002 (N=88). Outcome variable: Cases = <1500g neonatal deaths, not transferred in utero from Level 1 or 2 hospitals to the tertiary care, level 3, perinatal center. Controls = <1500g neonatal deaths, transferred to a perinatal center in utero. Analysis variables were Race and SES. Chi square test was performed, and the odds ratio (O.R.) calculated. RESULTS: Sixty percent (28/47) of African American patients were not transferred, in contrast to 68% (N=28/41) of patients of any other race (O.R. 0.68, P=0.39). Seventy-two percent (28/39) of low SES patients were not transferred, in contrast to 57 % (N= 28/49)of higher SES patients - O.R. 1.9 (P=0.16). Given the N in each group, a power of 86 % was reached. CONCLUSION: No differences were detected in racial distribution or in distribution of insurance status in the group of patients transferred compared with the group denied transfer to the tertiary care center. Rates of transfer and odds of transfer across populations, hospitals or perinatal systems are performance indicators that would indicate bias in access to transfer of care.