Association of universal bilirubin screening with socioeconomic disparities in newborn follow-up

Objective — To determine whether implementation of universal bilirubin screening in Ontario, Canada was associated with improved rates of recommended follow-up care across socioeconomic status (SES).

Methods — We conducted a retrospective population-based cohort study of all babies born at ≥ 35 weeks gestation and discharged to home within 72 hours from 97 hospitals between April, 2003 and February, 2011. We used linked administrative health datasets to measure recommended follow-up care (physician visit within one day of discharge for babies discharged ≤24 hours after birth, or physician visit within two days for babies discharged 24-72 hours after birth). We used maternal postal code and the Canadian Deprivation Index to determine material deprivation quintile. We modelled the relationship between universal bilirubin screening and outcomes using generalized estimating equations (GEE) to account for clustering by hospital, underlying temporal trends, and important covariates.

Results — Universal bilirubin screening was associated with a modest increase in recommended follow-up from 29.9 % to 35.0% (n=711,242, adjusted relative risk: 1.11, p=0.047). Disparity in recommended follow-up increased following screening implementation, with 40% of the crude increase attributable to the highest SES quintile and none to the lowest SES quintile.

Conclusions — Universal bilirubin screening has had only modest impact in ensuring timely follow-up for Ontario newborns, which represents an ongoing weakness in efforts to prevent severe hyperbilirubinemia. The observed increase in SES disparity in access to recommended follow-up suggests that universal programs which fail to address root causes of disparities may lead to overall improvements in population outcomes but increased inequity. What's new: The implementation of universal bilirubin screening within the context of universal healthcare coverage was associated with a modest increase in appropriate follow-up but increased socio-economic disparity in follow-up. Barriers to timely follow-up remain an obstacle to preventing severe hyperbilirubinemia.