729: Deconstructing trends in perinatal ethnic disparities in Hawaii

Abstract

ethnic disparities in Hawaii Timothy Dye, Hyeong Jun Ahn, John Chen, Marjorie Mau, Donald Hayes, Dena Towner John A. Burns School of Medicine, University of Hawaii, Obstetrics, Gynecology, and Women’s Health, Honolulu, HI, John A. Burns School of Medicine, University of Hawaii, Biostatistics, Honolulu, HI, John A. Burns School of Medicine, University of Hawaii, Native Hawaiian Health, Honolulu, HI, Hawaii State Department of Health, Family Services Division, Honolulu, HI OBJECTIVE: US OMB Directive 15 (OMB15) outlines requirements for reporting race/ethnicity. Oftentimes a range of distinct ethnicities are aggregated (e.g. “Asians”) in OMB15, perhaps masking important differences. These aggregations are particularly significant in Hawaii, a multiracial/multiethnic state significantly impacted by OMB15. This study’s purpose was to examine perinatal risk trends in Hawaii (HI) and among its ethnicities. STUDY DESIGN: Average Annual Percent Change (AAPC) in neonatal mortality rate (NNMR) and low birthweight (LBW) by state/ethnicity from 1969-2009 was computed using National Center for Health Statistics’ data. Birthweight distribution (BWD) reflecting LBW ( 2500 grams) and VLBW ( 1500 grams), and birthweight-specific mortality rate (BWSM) were generated from HI Department of Health (DOH) published data. RESULTS: HI’s NNMR declined 10 percent faster than did the US NNMR during the 1970s-80s (Table). Similarly, HI’s LBW/VLBW rates declined more rapidly than did US rates. In the 1990s, however, HI’s NNMR declined less rapidly than did the US and HI’s VLBW rate increased faster. These patterns worsened in the 2000s. Three concerning trends emerge. First, the Filipino LBW rate remains highest in Hawaii, 3/4ths higher than the white rate (Figure). Secondly, the Japanese NNMR rapidly increased throughout the 2000s, at a rate almost double that of Hawaiians, for instance (Table). Additionally, the Japanese LBW/VLBW rates increased much faster through the 2000s than they did in other ethnicities. Thirdly, the NNMR among Native Hawaiians remained at 50 percent higher than other ethnicities (Figure). This excess Native Hawaiian mortality is associated with higher BWSM (i.e. higher mortality among LBWs) when compared with other ethnic groups, rather than a skewed BWD. CONCLUSION: OMB15 aggregations mask important perinatal differences among Hawaii’s ethnicities. These patterns suggest that a range of strategies may be required to sufficiently address perinatal-related disparities. (NCRR U54RR026136/ NIMHD U54MD007584). 730 Association of parent smoking during pregnancy with offspring cardio-metabolic risk factors at age 17 Uri Dior, Yechiel Friedlander, Liron Kogan, Shani Shulman, Hagit Hochner Hadassah Medical Center and Hebrew University-Hadassah Medical School, Department of Obstetrics and Gynecology, Jerusalem, Israel, Hebrew University School of Public Health, Epidemiology unit, Jerusalem, Israel OBJECTIVE: Accumulating evidence demonstrates an association of maternal smoking during pregnancy with adverse metabolic neonatal outcomes. However, less is known about the influence of maternal or paternal smoking on cardio-metabolic risk factors in adolescence. Hence, we examined the association of maternal and paternal smoking during pregnancy with offspring weight, height, Body Mass Index (BMI), systolic and diastolic blood pressure (BP) at age 17. STUDY DESIGN: We used a population-based cohort of 11,729 births in Western Jerusalem during 1974-76, with available archival data on maternal, paternal and birth characteristics. Measurements at age 17 were assessed at military induction examinations. Linear regression models were used to evaluate the associations of parental smoking during pregnancy with offspring cardio-metabolic outcomes, after controlling for potential confounders. RESULTS: Maternal smoking during pregnancy, independent of paternal smoking and confounders (including socioeconomic status, maternal prepregnancy BMI and gestational weight gain, and offspring gender and birthweight) was positively associated with offspring’s height, weight and BMI at age 17 (all p-values 0.001, Table). For example, mean weight of offspring of smoking mothers was 1.5kg higher than weight of offspring whose mothers did not smoke. Paternal smoking was independently and positively associated with adolescent weight (p 0.001) and BMI (p 0.002) and negatively associated with systolic BP (p 0.02). An analysis examining whether smoking of at least one parent was associated with offspring outcomes yielded similar results. 3-yr combined low birthweight rate, birthweightspecific mortality rate (<2500 gr), and neonatal mortality rate by ethnicity, Hawaii 2007-2009 (Source: HI DoH) Average annual percent change (AAPC %) for selected perinatal outcomes, 1969-2009, USA, Hawaii, and Hawaii’s largest ethnic groups