Tiffany L Green1. 1. Department of Health Behavior and Policy, VCU School of Medicine , Richmond, Virginia.
Abstract
OBJECTIVE: To identify the contributions of individual-, household-, and area-level characteristics to disparities in the use of prenatal care (PNC). METHODS: This study used individual-level data from the 2001 Early Childhood Longitudinal Study-Birth Cohort linked to county-level U.S. Census data (N ≈ 5,200). I used nonlinear regression decomposition to quantify the contributions of several groups of factors-maternal health and pregnancy characteristics, preconception health behaviors, insurance coverage, PNC location, socioeconomic status (SES), and the social/economic and healthcare environments-to PNC disparities. RESULTS: Relative to whites, blacks and Hispanics were less likely to initiate first-trimester PNC and to have adequate PNC. The models explained 61.20%-79.90% and 52.15%-79.09% of the disparities in PNC initiation and adequacy, respectively. The most important factor was SES, which explained 50.68%-79.92% of the black-white gap and 37.50%-49.51% of the Hispanic-white gap in PNC use. Location of care, insurance status, and pregnancy characteristics also made significant contributions to these disparities. CONCLUSION: SES is a key driver of inequality in PNC, particularly black-white inequality. Addressing socioeconomic factors may improve PNC use among minorities.
OBJECTIVE: To identify the contributions of individual-, household-, and area-level characteristics to disparities in the use of prenatal care (PNC). METHODS: This study used individual-level data from the 2001 Early Childhood Longitudinal Study-Birth Cohort linked to county-level U.S. Census data (N ≈ 5,200). I used nonlinear regression decomposition to quantify the contributions of several groups of factors-maternal health and pregnancy characteristics, preconception health behaviors, insurance coverage, PNC location, socioeconomic status (SES), and the social/economic and healthcare environments-to PNC disparities. RESULTS: Relative to whites, blacks and Hispanics were less likely to initiate first-trimester PNC and to have adequate PNC. The models explained 61.20%-79.90% and 52.15%-79.09% of the disparities in PNC initiation and adequacy, respectively. The most important factor was SES, which explained 50.68%-79.92% of the black-white gap and 37.50%-49.51% of the Hispanic-white gap in PNC use. Location of care, insurance status, and pregnancy characteristics also made significant contributions to these disparities. CONCLUSION: SES is a key driver of inequality in PNC, particularly black-white inequality. Addressing socioeconomic factors may improve PNC use among minorities.
Keywords:
decomposition methods; maternal health; prenatal care
Authors: Michelle P Debbink; Lynda G Ugwu; William A Grobman; Uma M Reddy; Alan T N Tita; Yasser Y El-Sayed; Ronald J Wapner; Dwight J Rouse; George R Saade; John M Thorp; Suneet P Chauhan; Maged M Costantine; Edward K Chien; Brian M Casey; Sindhu K Srinivas; Geeta K Swamy; Hyagriv N Simhan Journal: Obstet Gynecol Date: 2022-01-01 Impact factor: 7.661
Authors: Pedro Henrique Alcântara da Silva; Kezauyn Miranda Aiquoc; Aryelly Dayane da Silva Nunes; Wilton Rodrigues Medeiros; Talita Araujo de Souza; Javier Jerez-Roig; Isabelle Ribeiro Barbosa Journal: Public Health Rev Date: 2022-07-04
Authors: Anne Chevalier McKechnie; Kari Erickson; Matthew B Ambrose; Sophie Chen; Sarah J Miller; Michelle A Mathiason; Kathy A Johnson; Steven R Leuthner Journal: Patient Educ Couns Date: 2020-08-18
Authors: Benjamin J Peipert; Melissa N Montoya; Bronwyn S Bedrick; David B Seifer; Tarun Jain Journal: Reprod Biol Endocrinol Date: 2022-08-04 Impact factor: 4.982