Neonatal mortality and disparities within the military health system

Introduction: Racial disparity exists in U.S. neonatal mortality; Black, non-Hispanic neonates are at higher risk of death. We aim to examine overall and race-specific neonatal mortality within the Military Health System (MHS). Methods: Retrospective cohort study of infants delivered within the MHS between 2013–2015. Variables were extracted from the Military Health System Data Repository. Results: There were 320,283 live births within the MHS from 2013–2015; 588 neonates died, a death rate of 1.84/1000. Cohort neonatal mortality and incidence of preterm delivery (7.2%) were lower than concurrent U.S. statistics. Black, non-Hispanic neonates had a 2-fold increased risk of death (OR: 2.11; 95% CI 1.73–2.56, p < 0.001) over White, non-Hispanic neonates. Officer versus enlisted rank conferred no difference in neonatal mortality (OR: 0.88; 95% CI 0.74–1.03). Conclusion: Neonatal mortality within the MHS is lower than in the U.S. Despite universal insurance coverage and access to care, racial disparity persists. Risk of death is not modified by socioeconomic status. These findings highlight the need for critical examination of healthcare equity within neonatal-perinatal medicine.