Association of Universal Bilirubin Screening With Socioeconomic Disparities in Newborn Follow-up

OBJECTIVE: To determine whether implementation of universal bilirubin screening in Ontario, Canada is 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 weeks' gestation and discharged to home within 72 hours from 97 hospitals between April, 2003 and February, 2011. We used linked administrative health data sets to measure recommended follow-up care (physician visit within 1 day of discharge for babies discharged 24-27 hours after birth, or physician visit within 2 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 modeled the relationship between universal bilirubin screening and outcomes using generalized estimating equations to account for clustering according to 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 = .047). Disparity in recommended follow-up increased after 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 a modest effect in ensuring timely follow-up for Ontario newborn babies, 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 that fail to address root causes of disparities might lead to overall improvements in population outcomes but increased inequity.