Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117138

Pamela C. Hull, PhD¹, Barbara J. Kilbourne, PhD¹, Dustin C. Brown, MA¹, RS Levine, MD², and CH Hennekens, MD, DrPH³. (1) Center for Health Research, Tennessee State University, 3500 John A. Merritt Blvd., Nashville, TN 37209, 615-320-3003, bkilbourne@tnstate.edu, (2) Family and Community Medicine, Meharry Medical College, 1005 D.B. Todd Jr. Blvd., Nashville, TN 37208, (3) Department of Epidemiology and Public Health, University of Miami, 1010 West 21st St, Maimi, FL 33101

Purpose: Analyze changes in infant (IMR) and neonatal (NMR) mortality rates by race associated with state level healthcare policy decisions.

Background: Over the past two decades, IMRs and NMRs declined for Whites and Blacks disproportionately. Racial gaps may widen while healthcare innovations occur when social inequality exists. State subsidized healthcare plans may minimize these effects. Colorado, Massachusetts and Tennessee chose different approaches to manage increasing Medicaid expenditures. Colorado continued traditional Medicaid. Tennessee adopted a waiver program extending coverage to non-Medicaid-eligible persons, but required managed care. Massachusetts developed state insurance programs to supplement Medicaid and expanded a large hospital uncompensated care pool.

Methods: We used a longitudinal design with quasi-equivalent comparison states. Pooled time-series cross-sectional models were estimated for: black IMR, white IMR, black/white IMR, black NMR, white NMR, and black/white NMR.

Results: IMRs significantly declined across time for Blacks and Whites in all three states. For Blacks, the IMR decline was significantly greater in Massachusetts (no difference between Colorado and Tennessee). For Whites, Colorado IMR declines were significantly lower than Massachusetts or Tennessee. The ratio of black/white IMRs increased slightly in Colorado and Tennessee, but remained at roughly 2.1 in Massachusetts. For NMRs, the greatest decrease occurred for Blacks in Massachusetts, and the smallest occurred for Whites in Colorado. Trends in race disparities matched those for IMRs.

Conclusions: The traditional model had the slowest declines in IMRs/NMRs. Managed care had steeper declines for Whites only. Massachusetts was the most successful at reducing IMRs and NMRs without increasing racial disparities.

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