Abstract
BackgroundEmpirical evidence regarding maternal quality and safety outcomes across heterogeneous Asian and Pacific Islanders subgroups in the United States is limited, despite the importance of this topic to health disparities research and quality improvement efforts.MethodsDetailed discharge data from all Hawai‘i childbirth hospitalizations (n = 75,725) from 2008 to 2012 were considered. Validated measures of maternal quality and safety were compared in descriptive and multivariable models across seven racial/ethnic groups: Filipino, Native Hawaiian, other Pacific Islander (e.g., Samoan, Tongan, Micronesian), Japanese, Chinese, white, and other race/ethnicity. Multivariable models adjusted for age group, payer, rural vs. urban hospital location, multiple gestation, and high-risk pregnancy.ResultsCompared to whites, Japanese, Filipinos, and Other Pacific Islanders had significantly higher overall delivery complication rates while Native Hawaiians had significantly lower rates. Native Hawaiians also had significantly lower rates of obstetric trauma in vaginal delivery with and without instruments compared to whites (Rate Ratio (RR):0.66; 95% CI:0.50-0.87 and RR:0.62; 95% CI:0.52-0.74, respectively). Japanese and Chinese had significantly higher rates of obstetric trauma for vaginal deliveries without instruments (RR:1.52; 95% CI:1.27-1.81 and RR:1.95;95% CI:1.53-2.48, respectively) compared to whites, and Chinese also had significantly higher rates of birth trauma in vaginal delivery with instrument (RR 1.42; 95% CI:1.06-1.91). Filipinos and Other Pacific Islanders had significantly higher rates of Cesarean deliveries compared to whites (RR:1.15; 95% CI:1.11-1.20 and RR:1.16; 95% CI:1.10-1.22, respectively). Other Pacific Islanders also had significantly higher rates of vaginal births after Cesarean (VBAC) deliveries compared to whites (RR: 1.28; 95% CI:1.08-1.51) and Japanese had significantly lower rates of uncomplicated VBACs (RR:0.77; 95% CI:0.63-0.94).ConclusionsSignificant variation was seen for Asian and Pacific Islander subgroups across maternal quality and safety outcomes. Notably, high rates of obstetric trauma were seen among Chinese and Japanese vaginal deliveries. Filipinos and other Pacific Islanders had high rates of Cesarean deliveries. Native Hawaiians had better quality and safety outcomes than whites on several quality and safety measures, including obstetric trauma during vaginal delivery. Other Pacific Islanders had high rates of VBACs, while Japanese had lower rates. This information can help guide clinical practice, research, and quality improvement efforts.
Highlights
Empirical evidence regarding maternal quality and safety outcomes across heterogeneous Asian and Pacific Islanders subgroups in the United States is limited, despite the importance of this topic to health disparities research and quality improvement efforts
Filipinos had significantly higher rates of Cesarean deliveries compared to whites (RR: 1.15; 95% confidence intervals (CI): 1.11-1.20) and significantly lower rates of non-complicated births compared to whites (RR: 0.96; 95% CI: 0.95-0.97)
We find notable differences between Native Hawaiians and other Pacific Islanders, in Cesarean delivery rates, which are significantly higher for other Pacific Islanders compared to whites in multivariable models, a difference not seen for Native Hawaiians
Summary
Empirical evidence regarding maternal quality and safety outcomes across heterogeneous Asian and Pacific Islanders subgroups in the United States is limited, despite the importance of this topic to health disparities research and quality improvement efforts. Childbirth hospitalizations represent a major expense for public and private insurers with a total cost of over $15 billion a year [1] Despite their high costs, U.S maternal and child outcomes are worse than most other developed countries across such critical factors as maternal and infant mortality and low birth weight [2,3], and are notably unequal by race/ethnicity [4,5]. U.S maternal and child outcomes are worse than most other developed countries across such critical factors as maternal and infant mortality and low birth weight [2,3], and are notably unequal by race/ethnicity [4,5] For these reasons, pregnancy and childbirth has been identified as a national priority area for health care quality improvement [6]. The prevention of harm to patients from their interaction with the health care system, has been called “the foundation upon which all other aspects of quality care are built” [8]
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