Multi-cultural surveillance for ectopic pregnancy: California 1991-2000.
BACKGROUND
National surveillance for ectopic pregnancy (EP), the primary cause of maternal death in the first trimester, began in 1970. EP rates peeked during the late 1980s and have been highest for African Americans. However, limited reports on EP rates exist for other racial/ethnic groups.


OBJECTIVE
To report state-level, multicultural trends in EP rates from 1991 to 2000.


METHODS
Secondary data analysis of the California hospital discharge database collected by the Office of Statewide Health Planning and Development by using codes 633.0-633.9, from the International Classification of Diseases, Ninth Revision. EP rates are reported per 1000 pregnancies.


RESULTS
From 1991 to 2000, 62,839 EP were reported in California. Mean EP rate was 11.2/1000, decreased from 15/1000 to 9.3/1000, and varied significantly by race/ethnicity and age. EP rates were highest among African Americans (25/1000) and lowest among Hispanics (7.7/1000); African Americans had higher odds of having EP relative to non-Hispanic Whites (odds ratio [OR] 2.14, 95% confidence interval [CI] 2.09-2.19). Women 35-44 years of age had the highest EP rates (17.6/1000) and higher odds of having EP compared to other age groups (OR 2.45, 95% CI 2.39-2.50). The highest rate of EP was found among African Americans 35-44 years of age (43.1/1000).


CONCLUSIONS
The study showed declining EP rates in California for all groups but highlights disparities in EP rates and the attenuated rate of decline for African Americans, which places them at highest risk of death in the first trimester. This study demonstrates the usefulness of analyzing state-level data that may differ from aggregated national data when studying culturally diverse populations.
Calderón
Jose L
JL
RCMI-Biomedical Research Center, Drew University Center for Cross-cultural Epidemiologic Studies, Women's Health Initiative Projects, The Charles R Drew University of Medicine & Science, Los Angeles, California, USA. drcalderon@sbcglobal.net
Shaheen
Magda
M
Pan
Deyu
D
Teklehaimenot
Senait
S
Robinson
Paul L
PL
Baker
Richard S
RS
D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D018864:Cultural Diversity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008875:Middle Aged; D010351:Patient Discharge; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011271:Pregnancy, Ectopic / Q000208:ethnology*