253 Current US birth data mask significant racial disparities in pregnancy outcomes

Abstract

CDC natality data report outcomes and characteristics in 3 major groups : Hispanic (H), non-Hispanic Black (NHB) and non-Hispanic White (NHW). We hypothesized that conflating race within Hispanic ethnicity makes it impossible to compare races independent of ethnicity and masks differences in outcomes between Blacks and Whites. We used the CDC natality data from 2016-2018 to evaluate the incidence of preterm, low-birthweights, and neonatal death (as indicated on birth certificates), by adjusting Hispanic ethnicity for race – Hispanic White (HW) , Hispanic Black (HB), NHW, and NHB – for nulliparous, singleton, vertex deliveries with a birthweight of 500 grams and higher. There was a total of 3,554,601 deliveries in this study. Of the 822,047 Hispanic births, 6.7% (n=54,902) were HB. The table shows the outcomes and characteristics separately by ethnicity adjusted by race. NHB had overall the highest neonatal mortality, preterm delivery, and low birthweight rates followed by HB. HW and NHW infants had the lowest neonatal mortality, preterm and low birthweight rates. Our study shows for the first time that by adjusting Hispanic ethnicity for race, Non-Hispanic-Black women have worse outcomes than both Non-Hispanic White women and Hispanic White women. The failure to adjust the ethnicity category of Hispanic for race makes black Hispanics disappear among all Hispanics, and masks worse outcomes for Black Hispanic pregnancies. As a result, a significant racial disparity is masked and not taken into account in setting healthcare priorities. Reporting conflated data of Black and White Hispanics implicitly makes Hispanic ethnicity into a race. Because of the unique existence of discrimination among Blacks in the United States, this conflation makes it potentially harmful for black Hispanics. To prevent this potentially distorting effect on health policy, we recommend that outcomes by Hispanic ethnicity should be reported adjusted for race.