Title

Racial/ethnic and rural/urban disparity in prenatal and obstetrical care in New York State

Date of Award

2007

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Social Sciences

Keywords

Prenatal care, Racial-ethnic disparity, Rural-urban disparity, Birth outcomes, Obstetrical care, LBW and preterm birth

Subject Categories

Medicine and Health | Race and Ethnicity | Social and Behavioral Sciences | Sociology

Abstract

Over the past decades, overall health of the American population has improved considerably; however, not all Americans have shared equally in those improvements. Disparities in health resources utilization and health outcomes among layers of population have long been a recognized public health problem.

This research explores factors affecting disparities in prenatal and obstetrical care among population groups in New York State (NYS) during two periods (1986 and 1996-97) and the extent to which these factors impact provided care and birth outcomes. Although research was primarily focused on racial/ethnic and rural/urban disparities, other factors contributing to disparities were considered. Two datasets are merged data from NYS Live Birth file and NYS Hospital Discharge Data Abstract from Statewide Planning and Research Cooperative System, consisting of 120,162 (1986) and 236,833 (1996-97) observations. Binary logistic regressions for total population and selected population categories were used to analyze adequacy of prenatal care, maternal and infant transport, provision of anesthesia and other selected obstetrical procedures, and birth outcomes, such as low birthweight and preterm birth.

Analysis showed that disparities were present among various layers of the population, including racial/ethnic groups. Racial/ethnic minorities were less likely to receive services and more likely to have poorer birth outcomes than their White counterparts in almost all aspects of care analyzed in this study. Differences in health care utilization between minorities and Whites were found to be especially pronounced in adequacy of prenatal care and receipt of procedures considered optional, such as anesthesia for vaginal birth in absence of delivery complications; epidural anesthesia for women with delivery complications or cesarean section; and chorionic villus sampling and amniocentesis. Race/ethnicity independently contributed to disparity in received care even among women with high-risk pregnancies.

In the rural/urban domain, disparity in adequate prenatal care between rural and urban populations decreased from 1986 to 1996-97. However, racial/ethnic disparity within each category (rural or urban) remained high and even increased among urban residents during the same time period.

Findings highlight the most vulnerable population groups in receiving adequate care and issues that need to be addressed by further research and changes in health policy.

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