The Association of Hospital Characteristics with Brachial Plexus Birth Injury

Objective Evaluate association between hospital characteristics and brachial plexus birth injury (BPBI) and whether associations vary by race. Study Design 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. Results 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. Conclusion 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.