ABSTRACT
Although the literature examining differences in necrotizing enterocolitis related to race, sex, ethnicity, socioeconomic position, and other factors is small, there are disparities in outcomes. Studies conducted over the last 25 years demonstrate that the risk of NEC and NEC-associated mortality is twofold to threefold higher among black infants compared to white infants. Hispanic infants are also at greater risk of NEC and NEC-attributable mortality compared to gestational age–matched white infants, though the data are inconsistent. Asian populations are poorly studied but appear to have NEC risk profiles similar to whites. Mechanisms to explain observed disparities between different groups with NEC are unclear and remain largely unexplored. Several hypotheses, including lower rates of breastmilk exposure and higher rates of group B streptococcal colonization and peripartum infection among black women, have been proposed. However, evidence supporting these associations is weak, and no studies have established causation. As the field of necrotizing enterocolitis research advances, it is imperative to include studies addressing health disparities. As the burden of disease is not distributed equally, enhanced understanding of susceptibility and resiliency due to sociocultural background and other factors must be considered to advance the goal of preventing NEC and improving health for all infants.
