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An epidemiologic perspective to assess the gap in preterm birth between African Americans and white Americans

Aziz R. Samadi, MD, DPH, MPH1, Robert M. Mayberry, MPH, PhD2, Ernest Alema-Mensah, MS, DMin2, and Ahmad Al–Mahmoud, PhD2. (1) Clinical Research Center, PHER, Morehouse School of Medicine, 720 Westview Drive, S.W., NA, Atlanta, ID GA 30310, 404 756-5232, samadia@msm.edu, (2) Program for Healthcare Effectiveness Research, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310

The purpose of this study was to develop epidemiologic modalities to assess the gap in preterm birth between African American (AA) and white American (WA) women. We identified Medicaid prequalified enrollees who delivered live-born infants in Georgia during 1998 (birth certificate) and linked with Medicaid claims data (1997-1998), constructing a retrospective pregnancy cohort from first prenatal care visit to delivery.

We used descriptive and multivariate methods to develop identical models to assess each race separately, avoiding the race interaction, socioeconomic and health insurance biases. We used logistic regression procedures for modelling to assess the adequacy of prenatal care and preterm.

Preterm rates(%) were 10.45 (95% confidence interval [CI]: 9.67-11.24) among AA(N=5807) and 9.10 (95% CI: 7.92-10.27) among WA (N=2309). Our logistic regression analysis showed similar protective effects for adequate prenatal care and adequate pregnancy weight gain for preterm among both races. However, the risk of premature rupture of membranes for preterm was five-fold greater among AA than among WA women (risk ratio [RR]=25.89; 95% CI: 17.03-39.30 among AA and RR=5.15;CI: 2.65-10.04 among WA) women. Risks of abrupto placentae, preeclampsia, and smoking for preterm birth among AA women were statistically significant.

Our findings suggest that among AA and WA women of similar socioeconomic status, and health insurance the gap in preterm birth rate is not significant in this population based study. The slightly higher rate of preterm among AA women can be explained by increased risks of premature rupture of membranes, preeclampsia, smoking, etc. Our findings of protective effects of adequate prenatal care and adequate weight gain during pregnancy are in line with other reports.

Learning Objectives:

Keywords: Pregnancy Outcomes, Prescription Drug Use Patterns

Related Web page: NA

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.

Maternal and Child Health Epidemiology

The 132nd Annual Meeting (November 6-10, 2004) of APHA