title: Medicaid pregnancy termination funding and racial disparities in congenital anomaly-related infant deaths.
abstract: OBJECTIVE
  To explore whether state restrictions on Medicaid funding for pregnancy termination of anomalous fetuses could be contributing to the black-white disparity in infant death resulting from congenital anomalies.
  
  
  METHODS
  Data on deaths resulting from anomalies were obtained from U.S. vital statistics records (1983-2004) and the Nationwide Inpatient Sample (2003-2007). We conducted an ecological study using Poisson and logistic regression to explore the association between state Medicaid funding for pregnancy terminations of anomalous fetuses and infant death resulting from anomalies by calendar time, race, and individual Medicaid status.
  
  
  RESULTS
  Since 1983, a gap in anomaly-related infant death has developed between states without compared with those with Medicaid funding for pregnancy termination (rate ratio in 2004 1.21, 95% confidence interval [CI] 1.18-1.24; crude risks: 146.8 compared with 121.7/100,000). Blacks were significantly more likely than whites to be on Medicaid (60.2% compared with 29.2%) and to live in a state without Medicaid funding for pregnancy termination (65.8% compared with 59.6%). The increased risk of anomaly-related death associated with lack of state Medicaid funding for pregnancy termination was most pronounced among black women on Medicaid (relative risk 1.94, 95% CI 1.52-2.36; crude risks: 245.5 compared with 129.3/100,000).
  
  
  CONCLUSIONS
  States without Medicaid funding for pregnancy termination of anomalous fetuses have higher rates of infant death resulting from anomalies than those with funding, and this difference is most pronounced among black women on Medicaid. Restrictions on Medicaid funding for termination of anomalous fetuses potentially could be contributing to the black-white disparity in anomaly-related infant death.
  
  
  METHODS
  II.
authors.affiliation: University of British Columbia, Department of Obstetrics & Gynaecology, Vancouver, British Columbia, Canada; the Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hutcheon
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bodnar
authors.forename: Hyagriv N
authors.initials: HN
authors.lastname: Simhan
mesh_terms: D000025:Abortion, Eugenic / Q000191:economics*; D001741:Black or African American / Q000706:statistics & numerical data*; D000013:Congenital Abnormalities / Q000208:ethnology / Q000401:mortality*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000208:ethnology* / Q000639:trends; D007231:Infant, Newborn; D008484:Medicaid / Q000191:economics*; D011247:Pregnancy; D012111:Residence Characteristics; D014481:United States; D044465:White People / Q000706:statistics & numerical data*