title: Maternal quality and safety outcomes for Asians and Pacific Islanders in Hawai'i: an observational study from five years of statewide data.
abstract: BACKGROUND
  Empirical evidence regarding maternal quality and safety outcomes across heterogeneous Asian and Pacific Islanders subgroups in the United States is limited, despite the importance of this topic to health disparities research and quality improvement efforts.
  
  
  METHODS
  Detailed discharge data from all Hawai'i childbirth hospitalizations (n = 75,725) from 2008 to 2012 were considered. Validated measures of maternal quality and safety were compared in descriptive and multivariable models across seven racial/ethnic groups: Filipino, Native Hawaiian, other Pacific Islander (e.g., Samoan, Tongan, Micronesian), Japanese, Chinese, white, and other race/ethnicity. Multivariable models adjusted for age group, payer, rural vs. urban hospital location, multiple gestation, and high-risk pregnancy.
  
  
  RESULTS
  Compared to whites, Japanese, Filipinos, and Other Pacific Islanders had significantly higher overall delivery complication rates while Native Hawaiians had significantly lower rates. Native Hawaiians also had significantly lower rates of obstetric trauma in vaginal delivery with and without instruments compared to whites (Rate Ratio (RR):0.66; 95% CI:0.50-0.87 and RR:0.62; 95% CI:0.52-0.74, respectively). Japanese and Chinese had significantly higher rates of obstetric trauma for vaginal deliveries without instruments (RR:1.52; 95% CI:1.27-1.81 and RR:1.95;95% CI:1.53-2.48, respectively) compared to whites, and Chinese also had significantly higher rates of birth trauma in vaginal delivery with instrument (RR 1.42; 95% CI:1.06-1.91). Filipinos and Other Pacific Islanders had significantly higher rates of Cesarean deliveries compared to whites (RR:1.15; 95% CI:1.11-1.20 and RR:1.16; 95% CI:1.10-1.22, respectively). Other Pacific Islanders also had significantly higher rates of vaginal births after Cesarean (VBAC) deliveries compared to whites (RR: 1.28; 95% CI:1.08-1.51) and Japanese had significantly lower rates of uncomplicated VBACs (RR:0.77; 95% CI:0.63-0.94).
  
  
  CONCLUSIONS
  Significant variation was seen for Asian and Pacific Islander subgroups across maternal quality and safety outcomes. Notably, high rates of obstetric trauma were seen among Chinese and Japanese vaginal deliveries. Filipinos and other Pacific Islanders had high rates of Cesarean deliveries. Native Hawaiians had better quality and safety outcomes than whites on several quality and safety measures, including obstetric trauma during vaginal delivery. Other Pacific Islanders had high rates of VBACs, while Japanese had lower rates. This information can help guide clinical practice, research, and quality improvement efforts.
authors.affiliation: Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Biomed T102, Honolulu, HI 96822, USA. tsentell@hawaii.edu.
authors.forename: Tetine
authors.initials: T
authors.lastname: Sentell
authors.forename: Ann
authors.initials: A
authors.lastname: Chang
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Cheng
authors.forename: Jill
authors.initials: J
authors.lastname: Miyamura
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000208:ethnology; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D002681:China / Q000208:ethnology; D005113:Extraction, Obstetrical / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D054624:Health Status Disparities; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000208:ethnology; D008849:Micronesia / Q000208:ethnology; D007744:Obstetric Labor Complications / Q000208:ethnology*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D036801:Parturition; D061214:Patient Safety; D010679:Philippines / Q000208:ethnology; D011247:Pregnancy; D019984:Quality Indicators, Health Care; D018947:Samoa / Q000208:ethnology; D014058:Tonga / Q000208:ethnology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult