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Leiyu Shi, DrPH, MBA1, Gregory D. Stevens, PhD2, John T. Wulu, PhD3, Robert Politzer, ScD4, and Jiahong Xu, MS, MPH1. (1) Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, 624 N. Broadway, Room 409, Baltimore, MD 21212, 410-614-6507, lshi@jhsph.edu, (2) Pediatrics, UCLA Center for Healthier Children, Families, and Communities, 1100 Glendon Ave, Suite 850, Los Angeles, CA 90024, (3) Office of Policy, Evaluation and Data, Bureau of Primary Health Care, HRSA, DHHS, 4350 East West Highway, 11th floor, Bethesda, MD 20814, (4) Office of Data, Evaluation, Analysis & Research, Bureau of Primary Health Care, HRSA/DHHS, 4350 East West Highway, 7th floor, Bethesda, MD 20814
Background: Despite great national wealth, the U.S. continues to rank poorly relative to other industrialized nations on basic health indicators, and with wide inequities by race and income. Although many factors contribute to this status, the U.S. still fails to provide basic health care to all its citizens, particularly those most in need. Embedded in this failure are well-known racial and ethnic disparities in perinatal care and birth outcomes. Objectives: To examine whether community health centers (CHCs) contribute to reducing racial/ethnic disparities in perinatal care and birth outcomes. This study also identifies CHC and patient characteristics associated with these experiences and outcomes. Methods: Annual reports were submitted to the Bureau of Primary Health Care (BPHC) over five years (1996-2001) by approximately 700 CHCs each year. The study uses the perinatal profile tables in the Uniform Data System (UDS), along with general data on patient, provider and center characteristics. Results: In 2001, about 80% of all CHC mothers were racial/ethnic minorities. Between 1996 and 2001, Hispanic CHC prenatal care users increased to over 51% of all CHC mothers, and teenage prenatal care users declined to 21.3%. Across all years, about 60% of pregnant CHC users sought prenatal care in the first trimester. More than 70% of CHC mothers received timely postpartum and newborn care. In 2001, Asian mothers were most likely to receive timely postpartum care (81.7%), followed by Hispanics (75.0%), blacks (70.8%), whites (70.7%), and American Indians (56.1%). In 2001, Asians were most likely to receive timely newborn care (80.3%), followed by American Indians (78.7%), Hispanics (76.3%), Blacks (69.9%), and Whites (66.7%). Having a family income at or below the federal poverty level was associated with less first-trimester prenatal care, more postpartum care and more newborn care. Having more obstretrician/gynecologists (OB/GYNs) per users in a center was associated with a higher rate of first trimester prenatal care, but less postpartum and newborn care, and higher very low birthweight rates. The gap between white and black mothers in rates of low birthweight appears smaller in CHCs (5.0%) compared to national gaps in rates for low socioeconomic status mothers (5.8%) and the overall maternal population (6.2%). Conclusions: Overall, CHCs appear to contribute to reducing racial/ethnic disparities in perinatal care experiences and outcomes. Further increasing prenatal care use in the first trimester, reducing teenage births, and increasing the proportion of OB/GYN physicians in CHCs could lead to further improvement in perinatal outcomes.
Learning Objectives:
Keywords: Health Disparities, Perinatal Outcomes
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
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