An Investigation of Racial and Ethnic Disparities in Birth Outcomes in Milwaukee, Wisconsin

Background:Wisconsin has one of the worst African American infant mortality in the nation, with most of the deaths occurring in the City of Milwaukee.

Objective:To examine factors associated preterm birth (PTB) and low birthweight (LBW) among racial/ethnic groups in Milwaukee.

Methods: Retrospective analysis of 151,869 singleton live births data (1993-2006) from the City of Milwaukee, Wisconsin. Multivariate logistic regression was used to examine the association of medical and demographic factors with PTB and LBW. Analyses were stratified by race/ethnicity.

Results: African-Americans, whites, Hispanics, and “other” racial groups accounted for 46%, 33%, 16%, and 5% of the births, respectively. The percentage of PTB (61%) and LBW (65%) birth was 3 times greater for African-American women compared to whites (PTB 24%, LBW 20%). Compared to white women, the odds of PTB were 82% and 35% greater for African-American and “other” minority women, respectively. All minority women had greater adjusted odds of LBW than whites, with African-American women at greatest risk (OR 2.36:2.23-2.49). Across racial/ethnic groups, significant predictors of both outcomes included being unmarried with no child's father on record, maternal smoking, chronic hypertension, previous PTB, and inadequate and adequate plus prenatal care. Paternity status had a gradient effect for whites and Hispanics with unmarried women with no child's father's name on record at greatest risk, followed by those with court-established paternity and those with paternity statement at lowest risk for both outcomes.

Conclusions/Implications: Implementing policies/programs that promote smoking cessation, proper management of maternal conditions, targeted interventions for women with previous PTB, and paternal involvement have the potential to reduce disparities in PTB and LBW.