Asthma in pregnancy--its relationship with race, insurance, maternal education, and prenatal care utilization.
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.


METHODS
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.
Chung
Katherine D
KD
Department of Epidemiology, UMDNJ-School of Public Health (SPH), Piscataway, NJ 08854-5635, USA. kchung@umdnj.edu
Demissie
Kitaw
K
Rhoads
George G
GG
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000150:complications / Q000453:epidemiology / Q000208:ethnology*; D015331:Cohort Studies; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D016015:Logistic Models; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000453:epidemiology / Q000208:ethnology*; D011295:Prenatal Care / Q000191:economics; D012959:Socioeconomic Factors