Choi Sugy, McElfish Pearl A, Brown Clare C
Department of Population Health, NYU Grossman School of Medicine 180 Madison Ave 351, New York, NY 10016, USA.
College of Medicine, University of Arkansas for Medical Sciences Northwest 2708 S. 48th Street, Springdale, AR 72762, USA.
Prev Med. 2025 Mar;192:108238. doi: 10.1016/j.ypmed.2025.108238. Epub 2025 Jan 30.
To evaluate disparities in prenatal care among granular (disaggregated) racial/ethnic subgroups overall and by nativity.
We analyzed singleton live births among United States (US) residents from the National Center for Health Statistics Birth Certificate Data (2018-2022) to evaluate first trimester prenatal care initiation and prenatal care adequacy using the Adequacy of Prenatal Care Utilization Index. We conducted multivariable logistic regressions and used marginal effects to assess adjusted differences among 7 broad racial/ethnic categories (e.g., Asian) and 16 disaggregated subgroups (e.g., Chinese). Disaggregated subgroups came from Asian, Native Hawaiian and Other Pacific Islander (NHPI) and Hispanic categories.
Among the sample (n=15,882,850), 78.4% had first trimester prenatal care, and 76.2% had adequate prenatal care. Adjusted rates of first trimester prenatal care ranged from 60.1% among NHPI individuals to 82.5% among White individuals, and prenatal care adequacy ranged from 54.3% among NHPI individuals to 80.1% among White individuals. Compared to US-born individuals, foreign-born individuals had lower first trimester care and prenatal care adequacy among most racial/ethnic broad categories and subgroups. The rates of both outcomes among each NHPI subgroup were lower than every other racial/ethnic subgroup evaluated.
Significant disparities in first trimester prenatal care initiation and adequacy exist based on race/ethnicity and nativity, with the largest disparities among NHPI individuals. These findings highlight the need for focused public health interventions to address disparities in prenatal care access and quality, ultimately promoting both infant and maternal health equity.
评估总体上以及按出生情况划分的不同种族/族裔细分亚组之间的产前护理差异。
我们分析了美国国家卫生统计中心出生证明数据（2018 - 2022年）中美国居民的单胎活产情况，使用产前护理利用指数充分性来评估孕早期产前护理的开始情况和产前护理的充分性。我们进行了多变量逻辑回归，并使用边际效应来评估7个主要种族/族裔类别（如亚洲人）和16个细分亚组（如中国人）之间的调整差异。细分亚组来自亚洲、夏威夷原住民和其他太平洋岛民（NHPI）以及西班牙裔类别。
在样本（n = 15,882,850）中，78.4%的人在孕早期接受了产前护理，76.2%的人接受了充分的产前护理。孕早期产前护理的调整率从NHPI人群中的60.1%到白人人群中的82.5%不等，产前护理充分性从NHPI人群中的54.3%到白人人群中的80.1%不等。与美国出生的人相比，外国出生的人在大多数种族/族裔主要类别和亚组中孕早期护理和产前护理充分性较低。每个NHPI亚组的这两个结果发生率均低于所评估的其他每个种族/族裔亚组。
基于种族/族裔和出生情况，孕早期产前护理的开始情况和充分性存在显著差异，NHPI人群中的差异最大。这些发现凸显了需要有针对性的公共卫生干预措施来解决产前护理可及性和质量方面的差异，最终促进婴儿和孕产妇健康公平。
