Not Always Black and White: Racial Bias for Birth Disparities from Excluding Hispanic Identification

摘要

Despite gains in prenatal care (PNC) usage and birth outcomes for minority women during the past few decades, observed disparities between non-Hispanic Whites, Blacks, and Hispanics persist. Using the National Center for Health Statistics’ (NCHS) natality files from 1981 through 1998, Alexander, Kogan, & Nabukera (2002) examined live births of U.S. residents by trimester in which PNC was initiated and the appropriateness of that care based on the Adequacy of Prenatal Care Utilization Index (APNCU) (Kotelchuck, 1994). They found racial disparities between White and Black women in both the trimester of PNC initiation and the number of PNC visits made. Alexander et al.(2002) noted reductions in racial disparities in PNC; specifically, Blacks were steadily increasing in the number of prenatal visits and in first trimester initiation of PNC. However, a weakness of their study was the exclusivity of racial categories; only White and Black racial groups were analyzed based on the mother’s self reported race. Other racial groups were not included because Hispanic data were not identifiable for some states during part of the study period, and other racial groups lacked sufficient numbers to establish trending in the categories of interest (Alexander et al., 2002). Thus Hispanics identified their race as White and their ethnicity as Hispanic. Alexander et al. counted both non-Hispanic Whites and Hispanics as ‘Whites’ regardless of ethnicity or the availability of ethnicity in their analysis. This created a potential source of bias, as one could speculate that the reported narrowing of racial disparities in the number of PNC visits and earlier initiation of care between Whites and Blacks could be the result of increasing births to Hispanic women included in the ‘White’ birth group. The reported narrowing of disparities could simply be the result of failing to separate Hispanic women in the analysis, a potentially significant portion of the ‘White’ group given their high fertility rates and increased percentage of the total U.S. population. While the expansion of Medicaid-sponsored funding for pregnant women likely contributed to some of the reported increases in earlier PNC initiation and the number of prenatal visits in the late 1980s and early 1990s (Hessol, Vittingoff, & Fuentes-Afflick, 2004; Hueston, Geesey, & Diaz, 2008), it is not clear if this expansion benefited one racial group over another, particularly when Hispanic ethnicity is taken into account. Therefore, the purpose of this study was to evaluate differentials in birth outcomes for singletons by race