RACE AND ETHNIC DIFFERENTIALS IN BIRTH OUTCOMES

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In light of known inequities as well as the rapid growth of minority populations (with much of the increase due to immigration), researchers and policy markers are increasingly interested in the health needs, problems, and progress of race/ethnic and nativity groups. However, multivariate models of birth outcomes comparing Hispanics and Asians with non-Hispanic blacks, and non-Hispanic whites in the U.S. are rare, partially because until recently, few data sets have existed which are large enough to allow analysis of more than a few race/ethnic populations. Thus, the general objective of this proposal is to examine, for the first time to our knowledge, the effects of race/ethnicity, nativity, and a wide range of demographic, socioeconomic, and biomedical factors on pregnancy outcomes (both birth outcomes and infant mortality) among 11 race/ethnic groups using a large, national representative data set. Specific aims include: (1) Document current pregnancy outcome differentials among 11 race/ethnic populations using the most recent National Center for Health for Health Statistics (NCHS) linked birth/infant death data for the entire U.S. (2) Explore whether, to what extent, and why, pregnancy outcomes of immigrants of various race/ethnic groups differ from those of their U.S.- born counterparts. (3) Model the effects, both direct and indirect, of demographic, socioeconomic, maternal health, behavioral, and biomedical risk factors on birth outcomes and determine whether the direction and magnitude of the effects of risk factors vary across specific race/ethnic groups and by nativity. (4) Model the effects, both direct and indirect, of the same risk factors of infant mortality risk controlling proximate risks, including birth outcomes. In addition to the general objective itself, the analysis is innovative in that it builds on an expanded conceptual scheme and measurement strategy that allows (1) identification of adverse birth outcomes that would go undetected with conventional demographic methods and (2) estimation of differential effects of the same risk factors on different outcomes and any interaction of these effects with race/ethnicity.