OBJECTIVE: This study examines racial/ethnic disparities in the rate of asthma during pregnancy, and examines insurance type, maternal education, and prenatal care initiation/utilization as potential determinants of the disparities. DESIGN AND SETTING: This historical cohort study utilizes the linked birth certificates and maternal hospital claims data for all singleton live births to New Jersey residents in New Jersey hospitals in 1989--1993 (N=556,597). RESULTS: Compared to whites, African-American (odds ratio, OR=1.56, 95% confidence interval, CI: 1.44, 1.70) and Hispanic (OR=1.35, 95% CI: 1.23, 1.49) mothers had elevated rates of asthma. Medicaid (OR=2.08, 95% CI: 1.87, 2.32) and Medicaid HealthStart (OR=2.23, 95% CI: 2.04, 2.44) enrollees, compared to those with traditional indemnity coverage, were more likely to have asthma during pregnancy. When measures of socioeconomic status were included in the model, the effect of race decreased. Insurance status was the most important of the socioeconomic factors and accounted for most of the racial/ethnic disparity in African Americans and Hispanics. CONCLUSIONS: Insurance type as a possible indicator of socioeconomic status explains much of the racial disparity in asthma during pregnancy. Monitoring the quality of medical care for disadvantaged women may have a significant public health impact.
OBJECTIVE: This study examines racial/ethnic disparities in the rate of asthma during pregnancy, and examines insurance type, maternal education, and prenatal care initiation/utilization as potential determinants of the disparities. DESIGN AND SETTING: This historical cohort study utilizes the linked birth certificates and maternal hospital claims data for all singleton live births to New Jersey residents in New Jersey hospitals in 1989--1993 (N=556,597). RESULTS: Compared to whites, African-American (odds ratio, OR=1.56, 95% confidence interval, CI: 1.44, 1.70) and Hispanic (OR=1.35, 95% CI: 1.23, 1.49) mothers had elevated rates of asthma. Medicaid (OR=2.08, 95% CI: 1.87, 2.32) and Medicaid HealthStart (OR=2.23, 95% CI: 2.04, 2.44) enrollees, compared to those with traditional indemnity coverage, were more likely to have asthma during pregnancy. When measures of socioeconomic status were included in the model, the effect of race decreased. Insurance status was the most important of the socioeconomic factors and accounted for most of the racial/ethnic disparity in African Americans and Hispanics. CONCLUSIONS: Insurance type as a possible indicator of socioeconomic status explains much of the racial disparity in asthma during pregnancy. Monitoring the quality of medical care for disadvantaged women may have a significant public health impact.