title: Disparities in pregnancy healthcare utilization between Hispanic and non-Hispanic white women in Rhode Island.
abstract: Low healthcare utilization is a prime contributor to adverse health outcomes in both the general population and the Hispanic community. This study compares background characteristics and rates of prenatal and postpartum health care utilization between Hispanic and non-Hispanic white women. Using the Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS), 2002-2008, we assess rates of prenatal and postpartum healthcare utilization relevant to maternal and neonatal care. Associations between maternal ethnicity and adequacy of health care utilization were quantified using survey weighted multivariable logistic regression. Compared with non-Hispanic white women, Hispanic women were younger (less than 24 years, 43.8% vs. 25.2%), had less education (less than 12 years of education, 38.2% vs. 10.6%), lower annual income levels (incomes less than $19,999, 72.2% vs. 21.7%), and lower insurance rates before pregnancy (47.8% uninsured vs. 12.8%). Hispanic women had higher odds of having delayed prenatal care (AOR 1.84, 95% CI 1.27-2.65) or inadequate prenatal care (AOR 2.01, 95% CI 1.61-2.50), and their children had higher odds of not having a 1-week check-up (AOR 1.73, 95% CI 1.21-2.47) or any well-baby care (AOR 3.44, 95% CI 1.65-7.10). Disparities in inadequate prenatal care and not having any well-baby care remained significant after adjusting collectively for age, marital status, education, income, and insurance status of mother and newborn. Although many previously uninsured women became insured during pregnancy, disparities in healthcare utilization remained. Interventions focusing on reducing barriers to access prior to and during pregnancy should consider potential structural, informational, and educational barriers.
authors.affiliation: Alpert Medical School of Brown University, Box G-A, Providence, RI 02912, USA. ericabromley@gmail.com
authors.forename: Erica
authors.initials: E
authors.lastname: Bromley
authors.forename: Anthony
authors.initials: A
authors.lastname: Nunes
authors.forename: Maureen G
authors.initials: MG
authors.lastname: Phipps
mesh_terms: D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008423:Maternal Age; D008425:Maternal Behavior; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011181:Postnatal Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012237:Rhode Island; D018570:Risk Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult