Racial differences in distribution of number of prenatal visits: analysis of US natality data

Abstract

Racial disparity in pregnancy outcomes is a major public health issue. We analyzed the distribution of the number of prenatal visits across races and ethnic groups to identify differences that may account for variations in pregnancy outcomes. In this study we used the 2016-2019 U.S. natality data provided by the CDC consisting of 15,340,627 births. The distribution of the number of prenatal visits of White, Black, Asian, and Hispanic patients were analyzed. A Z-test was performed to determine if the distribution differed from the White population. The effect of insurance/payment types was also considered. As shown in Table 1, there are significant differences in the insurance types among racial groups. Hispanic and Black populations had a higher number of Medicaid participation than the White population. Asian had significantly lower Medicaid enrollment. Self-pay percentage was higher in Hispanic and Asian races whereas only 2.2% of White and 3% of Black population were without insurance. Overall, the White population had more prenatal visits than other groups (p< 0.01) with the exception of the self-pay group where the Asian population had more prenatal visits. (p< 0.01). The Hispanic and Black populations had fewer prenatal visits regardless of the forms of insurance/payment, with Black race having the fewest number of prenatal visits. Compared to other groups, more White mothers had 11+ prenatal visits. Since an adequate number of prenatal visits in term patients is between 11-14, more White patients received an optimal number of prenatal visits in comparison to other groups. Our findings show that there is a racial difference in frequency of prenatal care, especially with fewer prenatal visits among the Black race. This trend exists regardless of insurance. Considering that the number of patients without insurance is low, the availability of insurance may not explain this phenomenon. Fewer visits in Black race is especially concerning as they have more adverse pregnancy outcomes. Resolving this disparity may improve pregnancy outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)