Schenker EL, Bell RM, Edwards C, Keesey J, Gregory KD, Kahn K; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1997; 14: 359-60.
RAND, Santa Monica, CA 90407-2138, USA.
RESEARCH OBJECTIVE: To determine whether there are differences in the rates of inadequate prenatal care and predictors associated with inadequate prenatal care among subgroups of Asians and Pacific Islanders (APIs) as well as between APIs and other racial/ethnic groups. STUDY DESIGN: We use a California secondary data file that was prepared by the Management and Outcomes of Childbirth (MOC) PORT and which combined all 1989 and all 1990 birth certificate records with 1990 census data (merged using the mother's zip code). We defined 14 categories of API race/ethnicity and 4 comparison categories of non-API race/ethnicity using the mother's self-reported data from the child's birth certificate. We created a main analysis file which contained all births to API mothers combined (n=105,705) and Native American mothers (n= 6225) during this period. In order to create a data set in which API subgroups were not overpowered by larger racial/ethnic groups, we took a stratlified random sample of the other comparison groups - African Americans, White Hispanics, and white non-Hhispanics - to achive sample sizes of approximately 50,000 each. Results presented in this poster were based on a 25% sample of the main file with an overall sample size of 65,843 births. Using Kotelchuck's Adequacy of Prenatal Care Utilization (APNCU) Index (Am J Public Health 1994; 84:1414-1420) and information available on the birth certificate, we defined a dichotomous "inadequate prenatal care" outcome variable as "yes" if the mother either initiated prenatal care late (after the 4th month of pregnancy) or received less than 50% of the number of prenatal care visits recommended by ACOG based on the gestational age of the infant at birth. We defined either dichotomous or categorical variables for each of the following known predictors of adequacy of prenatal care that were available on either the birth certificate or census files: (1) mother's place of birth (as born outside of the US); (2) mother's education level (as less than a high school, high school, or more than high school education); (3) mother's martial status (as not married); (4) insurance used to pay for prenatal care (as Medicaid/Medi-Cal); (5) type of hospital where the baby was delivered (as public hospital); (6) median family income at zip code level (as less than 185% of the poverty level, which is the income cut-off for qualification for Medicaid in California, and three other interquartile ranges); (7) mother's zip code (as rural); (8) mother's age (as 18 years or less, 19-24 years, 25-34 years, or 35 or more years); (9) the mother's parity (as first birth, second to fourth birth, five or more births); and (10) if the mother had more than one child, the spacing between the current birth and the previous birth (as less than 15 months between births). PRINCIPAL FINDINGS: The 14 subgroups of API experience widely varying rates of inadequate prenatal care as well as levels for predictors of prenatal care. Japanese, Chinese, and Koreans have the lowest unadjusted percentage of inadequate prenatal care, while Cambodians, Laotians, Samoans, and "other" Pacific Islanders have the highest unadjusted percentage of inadequate prenata care. The range of percentage of inadequate prenatal care for APIs is much broader than the range for the non-API comparison groups. In general, but not always, there is an association between higher percentages of inadequate prenatal care and poorer performance on predictors. This is reflected in the finding that when the rate of inadequate prenatal care is "adjusted" using the predictors listed above, we see less variation among APIs as well as between APIs and the comparison groups. even so, some API subgroups (namely Samoan, Guamanian, Hawaiian, and "Other Asian") continue to have high rates of inadequate prenatal care after adjustment. CONCLUSIONS: Based on our preliminary modeling, it appears that prenatal care rates could be improved by targeting outreach efforts for early prenatal care to specific APIs based upon their predictor profiles. The large variations in rates of inadequate prenatal care suggest that combining APIs based into group will not be a productive analytical or policy approach. Much work is still needed to better understand why APIs have very different rates of inadequate prenatal care, and how these rates can be improved. RELEVANCE TO CLINICAL PRACTICE AND POLICY: It is widely known that prenatal care is associated with poor maternal and child health outcomes like low birthweight and infant mortality. The US Public Health Service has identified a target for the year 2000 in which 90% of all pregnant women would receive prenatal care in the first trimester of pregnancy. Late initiation of prenatal care (beginning in the middle of the second trimester) is one of the major components by which Kotelchuck's APNCU Index would define a pregnant women as having inadequate prenatal care. [ABSTRACT TRUNCATED]
Publication Types:
Keywords:
- African Americans
- Asian Continental Ancestry Group
- Birth Certificates
- California
- Child
- Continental Population Groups
- Educational Status
- European Continental Ancestry Group
- Female
- Gestational Age
- Humans
- Income
- Infant
- Infant Mortality
- Infant, Low Birth Weight
- Medicaid
- Parity
- Poverty
- Pregnancy
- Prenatal Care
- Rural Population
- economics
- hsrmtgs
Other ID:
UI: 102233926
From Meeting Abstracts