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334813
Disparities in risk of fetal death associated with maternal age and race


Sunday, November 1, 2015

Anne Epstein, MPH, Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, AL
Whitney Smith, MPH, Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, AL
Samantha Goldfarb, DrPH, MPH, Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL
Martha Wingate, DrPH, MPH, Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, AL
background: Previous studies have noted that as maternal age increases, the risk of fetal mortality increases; however, variations by race have not been well-defined.  This study examines the association between maternal age and fetal death, considering racial disparities.  Our hypothesis states that not only will the risk of fetal death increase with advancing age but also the disparities between racial groups will widen as age increases.

 

methods: Using 2007-2012 NCHS data for singleton fetal deaths (late: 28+ weeks) and live births among non-Hispanic white (NHW) and black (NHB), we calculated fetal mortality rates (per 1000 deliveries) by age categories (<20; 20-29; 30-39; 40+) and multivariable logistic regression, controlling for maternal risk factors.  Odds ratios (ORs) and ratios of odds ratios (RORs) and 95% confidence intervals (CI) were used to examine changes across maternal age groups by race.  RORs examined racial disparities. 

 

results: Rates and risks of fetal mortality increased with age.  Compared to NHWs, NHBs had a decreased risk of late fetal death for women aged <20 (aOR=0.67, 95% CI=0.63-0.71), but the risk was higher for 40+ women (aOR=1.96, 95% CI=1.77-2.17).  Disparities in the risk of fetal death between NHB and NHW increased, but the magnitude was not consistent across age groups (<20:  ROR=1.18, 95% CI=1.14-1.23 compared to 40+, ROR=3.77, 95% CI=3.4-4.1).    

conclusions: Racial disparities in fetal mortality persist and increase with age, but disparities between blacks and whites widened as maternal age increases.  Both age and race should be considered in the prevention and intervention related to fetal death.

Learning Areas:

Diversity and culture
Epidemiology
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the patterns of fetal death across maternal age and race in the United States. Discuss racial disparities in fetal death between non-Hispanic whites and non-Hispanic blacks in the United States.

Keyword(s): Health Disparities/Inequities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a DrPH student in the Department of Health Care Organization and Policy at the UAB School of Public Health focusing on Maternal and Child Health Policy. I am also a part of the Maternal and Child Health Bureau training grant in our department.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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