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  • Asthma in Pregnancy: RESULTS

Descriptive Characteristics of the Study Population

Only the racial/ethnic groups of non-Hispanic whites (n=337,130), non-Hispanic African Americans (n= 102,129), and Hispanics (n=80,898) were used for the analyses presented in this report. Those with other race/ethnicity (n=36,440,6.6% of the study population) were excluded from the analyses because of their heterogeneity. The characteristics of the study population are displayed in Table 1. Higher percentages of African-American and Hispanic mothers were under the age of 25 years, as compared to white mothers. African-American and Hispanic mothers were more likely than whites to have less than 12 years of education, to have Medicaid as their primary source of medical insurance, or to lack healthcare coverage. African-American and Hispanic mothers were more likely than whites to receive inadequate or no prenatal care and had higher rates of initiating prenatal care in the second or third trimesters.

Racial/Ethnic Disparities in Asthma During Pregnancy

The overall rate of asthma during pregnancy among the three racial/ethnic groups for singleton, live births in New Jersey for the years 1989-1993 was 0.6% (0.79% for African Americans, 0.68% for Hispanics, and 0.51% for whites, see Table 2). In univariable analysis, African Americans (odds ratio, OR=1.56, 95% confidence interval, CI: 1.44, 1.70) and Hispanics (OR=1.35, 95% CI: 1.23, 1.49) were more likely than whites to have had asthma during pregnancy. Adjustment for the confounding effects of maternal age, parity, and maternal smoking during the index pregnancy did not substantially alter the results. As compared to whites, the adjusted OR (95% CI) was 1.51, (1.38, 1.66) for African Americans and 1.34, (1.21, 1.48) for Hispanics.

Table 1. Descriptive Characteristics of the Study Population

White

African-American

Hispanic

(n=337,130)

(n=102,129)

(n=80,898)

Maternal Age (Years), %
<15

0.1

0.9

0.5

15-19

3.8

20.1

14.8

20-24

14.3

30.3

29.6

25-29

33.4

25.6

29.1

30-34

34.1

16.2

17.8

35-39

12.6

5.95

6.9

40-44

1.7

0.97

1.3

45-55

0.1

0.0

0.1

Parity, %
Primipara 44.36 43.72 44.39
Multipara 55.64 56.82 55.61
Maternal Education (Years Completed), %
<12

7.1

25.9

34.9

12

37.0

42.9

37.4

13-15

19.5

15.9

13.3

>16

36.4

15.4

14.3

Marital status, current, %
Unmarried

11.2

66.3

42.8

Married

88.8

33.7

57.2

Insurance Type (Payer), %
Medicaid

3.8

20.2

15.9

Medicaid HealthStart

6.5

29.3

29.6

Selt-pay

5.5

12.1

13.9

Managed care

16.1

15.9

9.3

Indemnity

68.2

22.5

31.3

Trimester ot Prenatal Care Initiation, %
No prenatal care

0.3

4.9

1.2

First

89.6

62.9

68.9

Second

8.4

25.6

24.2

Third

1.7

6.6

5.6

APCU Index, %
Inadequate

7.7

30.0

22.7

Intermediate

17.8

16.4

17.6

Adequate

52.3

32.7

39.4

Adequate plus

22.2

20.9

20.3

Racial Disparities in Asthma During Pregnancy—Associations with Insurance

In univariable analysis, Medicaid (OR=2.08, 95% CI: 1.87, 2.32) and HealthStart (OR=2.23, 95% CI: 2.04, 2.44) enrollees, compared to those with indemnity coverage, were more likely to have asthma during pregnancy. Table 2 presents the rate of asthma during pregnancy for each of the race/ethnicity and health insurance categories. Medicaid and HealthStart enrollees had consistently higher rates of asthma during pregnancy across each of the racial/ethnic groups; and within each insurance category, the racial/ethnic variation in the rate of asthma during pregnancy was small. kamagra soft tablets

The odds of having asthma during pregnancy for each of the race/ethnicity and insurance categories, before and after adjustment for potential con-founders, are displayed in Table 3. Within each race/ethnicity category, Medicaid and HealthStart enrollees were consistently more likely than those with indemnity insurance to have asthma during pregnancy (Table 3). In addition, for African Americans, self-pay was a significant predictor of asthma.

Table 2. Rate of Asthma (%) Complicating Pregnancy by Race/Ethnicity and Insurance Type

Medicaid Medicaid HealthStart Self-pay Managed care Indemnity

Total

White (non-Hispanic)

0.82

0.95

0.45

0.55

0.47

0.51
African-American (non-Hispanic)

1.05

1.15

0.70

0.57

0.47

0.79
Hispanic

1.00

0.98

0.39

0.50

0.52

0.68
Total

0.96

1.02

0.49

0.54

0.46

0.60

Racial Disparities in Asthma During Pregnancy—Associations with Prenatal Care Initiation and Utilization

In analyses based on the APCU index, the adjusted odds (and 95% confidence intervals) of having asthma during pregnancy for African Americans and Hispanics as compared to whites were respectively: 1.30 (1.09, 1.55) and 1.39 (1.15, 1.68) for adequate plus utilization; 1.52 (1.31, 1.78) and 1.15 (0.97, 1.37) for adequate utilization; 2.00 (1.61, 2.50) and 1.91 (1.51, 2.41) for intermediate utilization, and 1.32 (1.08, 1.62) and 1.14 (0.90, 1.45) for inadequate utilization. canadian antibiotics

Results of an Overall Multivariable Model

When race was included in a multivariable logistic regression model with insurance type, maternal education, trimester of prenatal care initiation, and other con-founders, insurance type—particularly Medicaid (OR-1.98, 95% CI: 1.73, 2.27) and HealthStart (OR=2.10, 95% CI: 1.86, 2.36)—were significantly associated with asthma in pregnancy. Although race still remained a significant predictor of asthma during pregnancy for African Americans (OR=1.19, 95% CI: 1.07, 1.31), the original (unconditional) effect was diminished markedly. For Hispanics, race was no longer a significant predictor (OR=1.04, 95% CI: 0.93, 1.16).

Table 3. Relationship between Asthma Complicating Pregnancy and Markers of Socioeconomic Status According to Racial/Ethnic Groups (Odds Ratio, 95% Confidence Interval)

Unadjusted*

Adjusted*

White
Maternal education!
<12

1.20 (0.98, 1.46)

1.18 (0.95, 1.46)

12

1.12 (0.99, 1.26)

1.13 (1.00, 1.28)

13-15

1.16 (1.01, 1.33)

1.16 (1.01, 1.34)

Insurance type (payer)§
Medicaid

1.69 (1.35, 2.12)

1.68 (1.33, 2.12)

Medicaid HealthStart

2.01 (1.69, 2.39)

1.94 (1.62, 2.33)

Self-pay

0.92 (0.72, 1.17)

0.95 (0.75, 1.22)

Managed care

1.16 (1.02, 1.33)

1.17 (1.02, 1.34)

Trimester of prenatal care initiation**
None

1.59 (0.85, 3.00)

1.32 (0.65, 2.68)

Third

0.95 (0.68, 1.35)

0.96 (0.68, 1.37)

Second

0.85 (0.71, 1.02)

0.85 (0.71, 1.03)

African-American
Maternal education*
<12

0.98 (0.75, 1.27)

1.02 (0.77, 1.34)

12

1.02 (0.81, 1.30)

1.02 (0.80, 1.30)

13-15

0.96 (0.73, 1.28)

0.92 (0.69, 1.24)

Insurance type (payer)5
Medicaid

2.27 (1.75, 2.93)

2.36(1.81,3.08)

Medicaid HealthStart

2.49 (1.96, 3.16)

2.55 (1.99, 3.28)

Self-pay

1.44 (1.06, 1.97)

1.47 (1.06, 2.03)

Managed care

1.19 (0.89, 1.59)

1.20 (0.89, 1.62)

Trimester of prenatal care initiation**
None

0.91 (0.65, 1.28)

0.90 (0.63, 1.28)

Third

0.88 (0.66, 1.18)

0.93 (0.69, 1.25)

Second

0.88 (0.74, 1.04)

0.87 (0.73, 1.04)

Hispanic
Maternal education*
<12

1.10 (0.82, 1.47)

1.08 (0.79, 1.48)

12

0.93 (0.69, 1.24)

0.93 (0.69, 1.26)

13-15

0.97 (0.69, 1.38)

1.08 (0.75, 1.54)

Insurance type (payer)5
Medicaid

2.05 (1.57, 2.68)

2.05 (1.56, 2.70)

Medicaid HealthStart

1.92 (1.51, 2.44)

1.93 (1.50, 2.47)

Self-pay

0.78 (0.54, 1.13)

0.83 (0.57, 1.21)

Managed care

1.01 (0.70, 1.47)

0.97 (0.65, 1.43)

Trimester of prenatal care initiation**
None

0.28 (0.07, 1.12)

0.26 (0.07, 1.06)

Third

0.68 (0.45, 1.03)

0.57 (0.36, 0.90)

Second

0.81 (0.66, 1.00)

0.81 (0.65, 1.00)

* Adjusted for terms in the table; t Adjusted * plus for maternal age, parity, maternal smoking during
pregnancy. The reference category for J was >16 years of completed education; for § was indemnity;
and for ** was first trimester of prenatal care initiation.

Maternal education and trimester of prenatal care initiation were not associated with during pregnancy.

Results of a Sequential Multivariable Model

When age, parity, and smoking status were added sequentially in a logistic regression model, the estimated association between race and asthma during pregnancy did not change remarkably (Table 4). On the other hand, inclusion of insurance type reduced the odds ratio significantly, from 1.51 (1.38,1.66) to 1.18 (1.07,1.31). Inclusion of maternal education and trimester of initiation of prenatal care had almost no effect on the racial disparity in asthma. When the order was switched, and education was placed in the model before insurance status, maternal education caused only a slight decrease in the odds ratio from 1.51 (1.38, 1.66) to 1.45 (1.32, 1.59). The same pattern was true in analyses stratified by trimester of prenatal care initiation and APCU index.
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Table 4. Effect of Race; Results of a Sequential Multivariate Model

(Odds Ratio, 95% Confidence Interval)*

African-American Hispanic
Race

1.56 (1.44, 1.70)

1.35 (1.23, 1.49)

Age

1.53 (1.40, 1.67)

1.33 (1.21, 1.47)

Parity

1.51 (1.39, 1.65)

1.32 (1.19, 1.46)

Smoking

1.51 (1.38, 1.66)

1.34 (1.21, 1.48)

Insurance

1.18 (1.07, 1.31)

1.04 (0.93, 1.16)

Education

1.18 (1.07, 1.30)

1.03 (0.92, 1.15)

Trimester

1.18 (1.07, 1.31)

1.02 (0.91, 1.14)

* As compared to white women

Additional Analyses

Our finding that women who were enrolled in Medicaid or Medicaid HealthStart were more likely to have had asthma during pregnancy may have been confounded by multiple deliveries to the same women in the four-year time span of the dataset. In order to assure that such confounding is not an explanation for our results, we fit another multivariable model after restricting the data to nulliparas only. Analysis was also performed for each calender year separately. The results of these additional analyses were not substantially different from those reported above. buy kamagra

Summary of Results

In summary, we found coded asthma rates during pregnancy to be about 50% higher in African Americans and about 40% higher in Hispanics as compared to whites. However, results from multiple logistic regression demonstrated that insurance type explained much of the racial disparity in asthma during pregnancy.

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