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Evidence From California

Laurence C. Baker, PhD; Christopher C. Afendulis, PhD; Amitabh Chandra, PhD; Shannon McConville, MPP; Ciaran S. Phibbs, PhD; Elena Fuentes-Afflick, MD, MPH

Arch Pediatr Adolesc Med. 2007;161(1):69-76.

Objective  To obtain information about health outcomes in neonates in 9 subgroups of the Asian population in the United States.

Design  Cross-sectional comparison of outcomes for births to mothers of Cambodian, Chinese, Filipino, Indian, Japanese, Korean, Laotian, Thai, and Vietnamese origin and for births to non-Hispanic white mothers. Regression models were used to compare neonatal mortality across groups before and after controlling for various risk factors.

Setting  All California births between January 1,1991, and December 31, 2001.

Participants  More than 2.3 million newborn infants.

Main Exposure  Racial and ethnic groups.

Main Outcome Measure  Neonatal mortality (death within 28 days of birth).

Results  The unadjusted mortality rate for births to non-Hispanic white mothers was 2.0 per 1000. The unadjusted mortality rate for births to Chinese and Japanese mothers was significantly lower (Chinese: 1.2 per 1000, P<.001; Japanese: 1.2 per 1000, P=.004), and for births to Korean mothers the rate was significantly higher (2.7 per 1000, P=.003). For infants of Chinese mothers, observed risk factors explain the differences observed in unadjusted data. For infants of Cambodian, Japanese, Korean, and Thai mothers, differences persist or widen after risk factors are considered. After risk adjustment, infants of Cambodian, Japanese, and Korean mothers have significantly lower neonatal mortality rates compared with infants born to non-Hispanic white mothers (adjusted odds ratios, 0.58 for infants of Cambodian mothers, 0.67 for infants of Japanese mothers, and 0.69 for infants of Korean mothers; all P<.05); infants of Thai mothers have higher neonatal mortality rates (adjusted odds ratio, 1.89; P<.05).

Conclusions  There are significant variations in neonatal mortality between subgroups of the Asian American population that are not entirely explained by differences in observable risk factors. Efforts to improve clinical care that treat Asian Americans as a homogeneous group may miss important opportunities for improving infant health in specific subgroups.

Author Affiliations: Departments of Health Research and Policy (Drs Baker, Afendulis, and Phibbs and Ms McConville) and Pediatrics (Dr Phibbs), and Center for Primary Care and Outcomes Research (Dr Phibbs), Stanford University, Stanford, Calif; National Bureau of Economic Research, Cambridge, Mass (Drs Baker, Afendulis, and Chandra); Kennedy School of Government, Harvard University, Cambridge, Mass (Dr Chandra); Health Economics Resource Center, Center for Health Care Evaluation, and Cooperative Studies Program, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (Dr Phibbs); Departments of Pediatrics, and Epidemiology and Biostatistics, University of California, San Francisco (Dr Fuentes-Afflick).