# The Association of Hospital Characteristics with Brachial Plexus Birth Injury

## TL;DR

This study finds that hospital characteristics, including patient demographics, are linked to brachial plexus birth injuries, with higher odds in hospitals serving more Black infants.

## Contribution

The study identifies structural differences in obstetric care delivery associated with racial disparities in brachial plexus birth injuries.

## Key findings

- Lower obstetric care level and complications are associated with brachial plexus birth injury (BPBI).
- Hospitals with a higher proportion of Black births show higher odds of BPBI even after adjusting for risk factors.
- Associations between hospital characteristics and BPBI are consistent across racial groups.

## Abstract

Evaluate association between hospital characteristics and brachial plexus birth injury (BPBI) and whether associations vary by race.

Retrospective study of liveborn infants from 1997–2019 using the Kids’ Inpatient Database linked to American Hospital Association Annual Survey. Multivariable logistic regression models were used to assess adjusted associations between hospital characteristics and BPBI. Interaction terms were examined to evaluate effect modification by race.

7,824,862 sampled infants, representing 25,400,023 infants in the population, were included. After adjustment, lower obstetric care level, complications, or hospitals within highest quartile of Black births were associated with BPBI. Associations between hospital characteristics and BPBI were consistent across racial groups.

Hospital characteristics reflecting institutional resources, quality, and patient population are associated with BPBI. BPBI odds were greatest in hospitals with greater proportion of Black infants even after adjustment for individual sociodemographics and risk factors, suggesting additional, unmeasured structural differences in obstetric care delivery.