Minneso
ota Departm
ment of Hea
alth & Minne
esota Depa
artment of H
Human Serrvices
Octoberr 2010
Popullations of
o Colorr and the
e Life Co
ourse Pe
erspectiive:
A Com
mparison of Low
w Birth Weight
W
O
Outcom
mes betw
ween
Medic
caid and
d Non-Me
edicaid Births, Minneso
ota 2005
5-2007
This fact sheet summ
marizes resultts from the report
r
“The B
Birth Certifiicate and Meedicaid Dataa
Match Prroject: A Comparison off Low Birth Weight
W
Outccomes amonng Medicaid and NonMedicaid
d Funded Birrths in Minn
nesota.” Thiss report exam
mines the diffference in loow birth weiight
(LBW) in
ncidence am
mong populattions of colo
or between M
Medicaid-funnded and nonn-Medicaid
births in Minnesota for
f calendar years 2005-2
2007. It alsoo describes thhe life coursse approach tto
address the issues raiised by the African
A
Ameerican disparrity in LBW..
Background
Low birth
h weight (LB
BW) is defin
ned as a birth
h weight of lless than 25000 grams (5..5 pounds). L
LBW
has both immediate and
a long-term
m impacts on
n health. It iis a significaant predictor of infant
mortality
y, and disabillities and ho
ospitalization
ns during chiildhood. LBW
W is also associated witth an
increased
d risk of hearrt disease, ty
ype 2 diabetees, and otherr chronic dissease in adullthood.1,2
Previous research has shown thatt infants born
n to low incoome womenn are more likkely to be L
LBW
than infants born to women
w
from
m higher inco
ome familiess.3 Income daata is not available on biirth
certificattes in Minnesota, but maaternal enrolllment in Me dicaid at thee time of delivery can bee
used as a proxy for lo
ow income.
Method
ds
Minnesotta resident birth
b
certificaates were lin
nked with Meedicaid enroollment and cclaims data uusing
the namee of the moth
her, the child
d’s date of biirth, and other identifierss. Medicaid--funded birthhs
were defi
fined as thosee for which the
t birth certtificate matcched with M
Medicaid dataa. Non-Mediicaid
births inccluded the reemaining birrth certificatees. Medicaidd births incluude Medical Assistance and
MinnesottaCare births.
Findings
Materna
al Race
African Americans/B
A
Blacks had a
significan
ntly higher rate
r of LBW
W than all
other maternal race groups
g
in botth
Medicaid
d and non-M
Medicaid populations
(Figure 1).
1 Births to Asians/Pacif
A
fic
Islanderss were also significantly more
likely to be LBW thaan births to Whites
W
in both populations.
Other ressearchers hav
ve found a
persisten
nt disparity in
n LBW betw
ween
African Americans
A
and
a other racce/ethnic
groups in
n the US. Lo
ow income am
mong
African Americans
A
iss an explanaation
frequentlly given for this
t disparity
y, but
Figure 1. Perceentage LBW births by materrnal race and Medicaid stat us, Minnesotaa 2005‐2007. Popula
ations of Color and the Life
e Course
e Perspec
ctive:
A Com
mparison of LBW Outcomes
O
s betwee
en Medica
aid
and No
on-Medic
caid Births, Minnes
sota 2005
5-2007
Pag
ge 2
the resultts of this study show thaat when incom
me is accounnted for by M
Medicaid staatus, Africann
American
ns still have a significan
ntly higher raate of LBW. In other woords, Africann American rrace
and low income
i
are two
t independ
dent risk facctors for LBW
W in Minnessota.
Higher raates of LBW
W among birtths to Asian women
w
mayy be related tto smaller boody size, andd this
does not appear to traanslate to a higher
h
risk of
o morbidity or mortalityy among Asian infants.4 In
contrast, American In
ndian infantss had rates of
o LBW com
mparable to W
Whites, but ttheir risk of
infant mo
ortality has been
b
found to
t be relativeely high due to causes unnrelated to L
LBW.5
Materna
al Hispanic
c ethnicity
Births to Hispanic wo
omen, who may
m be of an
ny race, havee a significanntly lower raate of LBW than
births to non-Hispaniics in the Meedicaid
Figure 2. Perccentage LBW b
births by mateernal Hispanic populatio
on. In the non-Medicaid
ethnicity and
d Medicaid stattus, Minnesotaa 2005‐2007.
populatio
on, Hispanics and non-H
Hispanics
do not diiffer in LBW
W (Figure 2).
These ressults are con
nsistent with previous
research showing thaat Hispanics,,
particularrly women of
o Mexican origin,
o
have low
w risk of LBW
W in spite off high
poverty rates
r
in the US.
U This has been
identified
d by some reesearchers ass the
“Hispaniic Paradox”. Explanatorry
theories include
i
betteer social support, less
smoking,, alcohol, an
nd drug use, good
g
health haabits develop
ped in their home
h
countriess, better diet,, and that wo
omen
who imm
migrate are liikely to be in
n good
health.6,7
The Liffe Course
e Perspective
African Americans
A
in
n both Medicaid and non
n-Medicaid ppopulations had LBW raates that werre
significan
ntly higher than
t
those off any other group.
g
Unlikke teen pregnnancy, tobaccco use, and
inadequaate prenatal care,
c
race is not
n a modifiiable risk facctor for LBW
W. Thereforee, a differentt
approach
h is needed to
o reduce the high rates of
o LBW expeerienced by African Am
mericans.
The impaact of race on
n adverse biirth outcomees such as LB
BW, morbiddity, and infaant mortality
must be better
b
undersstood in ordeer to addresss underlyingg issues and rroot causes oof these
disparitiees. Discrimin
nation and disadvantage over a lifetiime create phhysiologicall changes in the
body inclluding increased production of the sttress hormonne, cortisol, and decreassed immune
function leading to in
nfections. Bo
oth stress an
nd infections have been sshown to inccrease rates oof
preterm and
a low birth
h weight bab
bies.8, 9 Yearrs of researchh have identtified that theese conditionns
cannot bee adequately
y addressed, even with th
he best prenaatal care, in nnine monthss of pregnanccy.
Research
hers and poliicy makers have
h
proposeed a 12 pointt plan to reduuce racial diisparities in bbirth
outcomess informed by
b this life co
ourse perspeective.8 This broad and ffar reaching pplan goes
beyond prenatal
p
care to address the
t health caare needs of A
African Am
merican womeen across theeir
Popula
ations of Color and the Life
e Course
e Perspec
ctive:
A Com
mparison of LBW Outcomes
O
s betwee
en Medica
aid
and No
on-Medic
caid Births, Minnes
sota 2005
5-2007
Pag
ge 3
life coursse; it goes beeyond indiviidual-level in
nterventions to address ffamily and ccommunity
systems; and it goes beyond
b
the medical
m
mod
del to addresss social andd economic innequities thaat
h disparities.
underlie many health
12‐point plan to closse the Black‐W
White gap in birth outcom
mes8 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Provvide interconception care to women with prior adveerse pregnanccy outcomes Increase access tto preconcepttion care to A
African Ameri can women
Improve the quality of prenattal care Expaand healthcare access ove
er the life course Stre
engthen fathe
er involvemen
nt in African A
American fam
milies Enhance coordination and integration of faamily supportt services Creaate reproducttive and sociaal capital in African Americcan communiities Inve
est in community building and urban re
enewal Closse the educattion gap Reduce poverty aamong African American ffamilies Support working mothers and
d families Und
do racism The roless of public health,
h
the heealth care sysstem, comm
munity-based programs, aand health caare
insurancee can be deteermined with
hin this list. Current effoorts in Minneesota to accoomplish seveeral
of these objectives,
o
such as proviiding precon
nception caree, improvingg quality of aand access too
prenatal care,
c
and sup
pporting maternal and faamily behaviior change sshould be brooadly supporrted
and expaanded. In add
dition, policy
ymakers’ atttention shoulld be drawn to initiatives that addresss the
root causses of dispariities in birth
h outcomes, particularly
p
ssocioeconom
mic disparitiees.
The full report, “Th
he Birth Cerrtificate and
d Medicaid Data Match
h Project: A Comparisson
B
Weigh
ht Outcomess among Meedicaid and
d Non-Mediccaid Funded
d Births in
of Low Birth
Minneso
ota,” is availlable at http
p://www.hea
alth.state.m
mn.us/divs/ch
hs/raceethn/index.htm..
Refere
ences
1. Goldenberrg RL, Culhane JF. Low birth weightt in the United Staates. Am J Clin Nu tr. 2007;85(suppl)):584S-590S.
2. Langley-E
Evans SC. Develop
pmental programm
ming of health and disease.
d
Proc Nutrr Soc. 2006;65(1): 97-105.
3. Kramer MS, Seguin L, Lydo
on J, Goulet L. Soccio-economic disparities in pregnanccy outcome: why ddo the poor fare soo poorly? Paediatrric and
Perinatal Epidemiology.
E
200
00;14:194-210.
4. Kierans WJ,
W Joseph KS, Luo
o ZC, Platt R, Wilk
kins R, Kramer MS. Does one size ffit all? The case foor ethnic-specific standards of fetal ggrowth.
BMC Preg
gnancy Childbirth. 2008 Jan 8; 8:1
5. Alexanderr GR, Wingate MS, Boulet S. Pregnaancy outcomes of American
A
Indians:: Contrasts amongg regions and with other ethnic groupps.
Matern Ch
hild Health J. 2008
8;12 Suppl 1:5-11.
6. Acevedo-G
Garcia D, Soobadeer MJ, Berkman LF
F. Low birth weigh
ht among US Hisppanic/Latino subgrroups: The effect oof maternal foreignn-born
status and education. Soc Scii Med. 2007;65 (12
2):2503-16.
L, Chireau MV, Jalllah Y, Howard D.. The “Hispanic paaradox”: An investtigation of racial ddisparity in pregnaancy outcomes at a tertiary
7. Brown HL
care mediccal center. Am J Ob
bstet Gynecol. 200
07 Aug; 197(2):197.el-7; discussion 197.e7-9.
8. Lu MC, Kotelchuck M, Hog
gan V, Jones L, Wrright K, Halfon N. Closing the blackk-white gap in birthh outcomes: A lifee course approach.. Ethn
2 – S2-76.
Dis.2010; 20 (suppl 2):S2-62
mus AT, Hicken M,
M Keene D, Bound
d J. “Weathering” and age patterns oof allostatic load s cores among blackks and whites in thhe
9.
Geronim
United States. AJPH. 2006; 96(5): 826-833.
Perforrmance Measureement
and Quality Improvem
ment
PO Bo
ox 64986
St. Pau
ul, MN 55164-0
0986
www.dhs.state.mn.us
MN Center for Heallth
Statiistics
PO B
Box 64882
St. P
Paul, MN 55164--0082
www
w.health.state.mnn.us