Progress Toward Elimination of Health Disparities

The following discussion highlights progress toward the elimination of health disparities. The disparities are illustrated in the Disparities Table (see Figure 16-2), which displays information about disparities among select populations for which data were available for assessment.

Disparities in the maternal, infant, and child health objectives were evident among racial and ethnic populations. The Asian population had the best rates for several objectives, including those for fetal and infant deaths (16-1a through f), very low birth weight births (16-10b), preterm births (16-11a, b, and c), abstaining from cigarette smoking in pregnancy (16-17c), and breastfeeding in the early post partum and 6-month post partum periods (16-19a and b). The white non-Hispanic population had the best rates for many objectives, including infant deaths due to congenital heart defects (16-1g), maternal deaths (16-4), prenatal care (16-6a and b), attendance at childbirth classes (16-7), infants put to sleep on their backs (16-13), mental retardation (16-14a), cerebral palsy (16-14b), age at diagnosis for autism spectrum disorder (16-14c), consumption of folic acid (16-16a and b), FAS (16-18), breastfeeding at 1 year (16-19c), and service systems for children with special health care needs (16-23).

The disparities in infant deaths, both during the neonatal and the postneonatal periods (16-1c, d, and e), between the group with the best rates (the Asian population) and the Hispanic, white non-Hispanic, and black non-Hispanic populations increased significantly between 1998 and 2002. The increase in the disparities from the best group for the black non-Hispanic and the white non-Hispanic groups for infant death rates (6-1c, d, and e) may be related to the increase in disparities for these populations for very low birth weight (16-10b). The disparities between the Asian or Pacific Islander and the non-Hispanic black and white populations decreased for deaths of children aged 1 to 4 years (16-2a). While the disparity between the black non-Hispanic and Asian or Pacific Islander populations in death rates for adolescents aged 10 to 14 years increased, disparities decreased between these populations for deaths of adolescents aged 15 to 19 years (16-3b) and young adults aged 20 to 24 years (16-3c).

The American Indian or Alaska Native group also showed higher rates than the best group for fetal and infant deaths (16-1a through h), child deaths (16-2a and b), adolescent and young adult deaths (16-3a, b, and c), preterm delivery (16-11a through c), and FAS (16-18), as well as lower rates than the best group for prenatal care use (16-6a and b).

Black non-Hispanic women are at a higher risk of having low and very low birth weight babies (16-10a and b).³⁰ The greatest disparities from the best group rate for preterm delivery (6-11a, b, and c) were seen among black non-Hispanic women. Bacterial vaginosis has been shown to be associated with preterm deliveries³¹ and may contribute to the higher rate. Programs such as the Healthy Start Initiative seek to reduce rates of infant death and associated risks in disproportionately affected communities.³²

The black population also showed an increase in the disparities for mental retardation and cerebral palsy (16-14a and b), compared with the white population.³³ The disparities in the rates for mental retardation may be the result of differential patterns of referral for IQ testing, postnatal factors such as lead poisoning and anemia, and maternal conditions such as high blood pressure, diabetes, and sickle cell disease.³⁴ Differences in low birth weight may also be linked to these disparities in rates of cerebral palsy.³⁴

Of particular concern are the increases in disparities for smoking during pregnancy for the American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, Hispanic, black non-Hispanic, and white non-Hispanic populations, compared with the Asian population, which had the lowest rate for smoking during pregnancy (16-17c). Although Asian women met the target of 99 percent abstaining from smoking during pregnancy, the other racial and ethnic populations made little progress toward this target.

Of those objectives tracked by gender, females had the better rates for fetal, perinatal, and infant deaths (16-1a through e, g, and h), child deaths (16-2a and b), adolescent and young adult deaths (16-3a, b, and c), preterm births (16-11a, b, and c), mental retardation (6-14a), cerebral palsy (16-14b), age at identification of autism spectrum disorder (16-14c), hospitalizations for sickle cell disease (16-21), and service systems for children with special needs (16-23). Gender disparities of 100 percent or more existed for deaths of adolescents aged 15 to 19 years (16-3b) and deaths of young adults aged 20 to 24 years (16-3c). Gender disparities increased significantly for postneonatal deaths (16-1e), deaths of children aged 1 to 4 years (16-2a), and mental retardation (16-14a). Males had a better rate than females for low birth weight (16-10a).

Persons with at least some college education had the best rate for all objectives demonstrating significant disparities by education level, except for cesarean births to low-risk women (16-9a and b). This group reported the best rates for many objectives: fetal, perinatal, and infant deaths (16-1a through h), maternal deaths (16-4), prenatal care (16-6a and b), childbirth classes (16-7), low birth weight (16-10a and b), preterm births (16-11a, b, and c), folic acid consumption (16-16a and b), abstaining from cigarette smoking (16-17c), breastfeeding (16-19a through d), and service systems for children with special health care needs (16-23). Persons with less than a high school education demonstrated rates that were at least double the rates of persons with at least some college for postneonatal deaths (16-1e), infant deaths due to SIDS (16-1h), early entry into prenatal care (16-6a), attendance at childbirth classes (16-7), abstinence from smoking during pregnancy (18-17c), and breastfeeding during the early post partum period (16-19a). Women with less than a high school education also had the lowest median RBC folate level (16-16b).

Education level in women affects parity and the risk of adverse birth outcomes.³⁵ Pregnant women with higher levels of education may adopt healthy behaviors and habits more readily than other pregnant women.²³ Increased maternal education has been shown to be associated with lower risk of low birth weight for both black non-Hispanic and white non-Hispanic infants, as well as with protection against infant deaths.³⁶

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