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Infant Race at Birth and Death as Recorded on Minnesota Vital Records, 19901999

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Infant Race at Birth and Death. as Recorded on Minnesota Vital Records, 1990-1999 ... Race on birth and death records ... birth and death records provide more ... – PowerPoint PPT presentation

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Title: Infant Race at Birth and Death as Recorded on Minnesota Vital Records, 19901999


1
Infant Race at Birth and Deathas Recorded on
Minnesota Vital Records, 1990-1999
  • Wendy L. Hellerstedt, MPH, PhD
  • Associate Professor
  • School of Public Health
  • Division of Epidemiology
  • Maternal and Child Health Program

2
Introduction Race identification
  • Race is often thought of as a social--not a
    genetic--factor
  • Self-identified race is acceptable in public
    health research
  • Some studies have shown that race changes for
    the same individual from survey to
    survey--sometimes depending on mode or type of
    survey administration

3
Race on birth and death records
  • Twin Cities one of the highest rates of births
    to parents of different races
  • Census 2000, MN 1.7 checked more than one race
    (in U.S., 2.4)
  • Racial misidentification on vital records could
    be related to multiple race identity, clerical
    error, or other biases related to self-report
  • Racial identification is important because
    federal and state funds are directed at health
    indices that disproportionately affect groups
    defined by race or ethnicity

4
Coding race on birth certificates
  • Since 1989, NCHS started tabulating U.S. birth
    data primarily by race of mother because
  • increased incidence of births to parents
    from different races 5.3 in 2000
  • large proportion of births with no data
    about father 14 in 2000
  • If race of mother is not known, fathers race is
    used, if known. Race of mother was not known for
    0.5 births in 2000

5
Race and infant mortality
  • Infant mortality rates in the U.S.--and within
    states--are at least twice higher among
    African-Americans and American Indians compared
    with whites
  • Hahn, et al. (JAMA, 1992) examined U.S.
    birth-death records and found inconsistencies in
    infant race at birth and death low for whites
    (1.2) and greatest for races other than white or
    black (43). Their work preceded the NCHS rule
    that defined infant race as mothers race.

6
Purpose
  • Examine infant race at birth--using the NCHS
    coding rules for identification of births by
    maternal race--and race as coded on the death
    certificate
  • Examine the maternal and paternal characteristics
    of infants who have different races at birth and
    death

7
Methods
  • Minnesota linked birth-death files, 1990-1999
  • Birth certificates available for 99 all
    resident births
  • 4302 deaths to infants who died within first 365
    days of life
  • Birth certificates included maternal and paternal
    race, age, and education. Also includes some
    prenatal health data for mother
  • Missing data were recorded as such and kept in
    analyses

8
Definitions of race at birth
  • Maternal race
  • If maternal race is missing, paternal race
  • If both races missing, code infant race as
    missing
  • Note MN (and U.S.) dont report infant race
    data are reported by maternal race (and paternal
    race if maternal data missing).

9
Infant race at death
  • Reported by next of kin to medical
    examiner or coroner (all infant deaths
    autopsied)
  • Minnesota does not impute missing race
    data

10
Analysis
  • Descriptive
  • Multivariate, stepwise logistic regression to
    determine correlates of inconsistent race coding

11
Products of analyses
  • Sample characteristics
  • Differences between race coding at birth and
    death
  • Correlates of differences

12
Maternal and paternal age of Minnesota infants
who died, 1990-1999, n 4302
  • 78.7 records had maternal and paternal data for
    age
  • 63.6 of mothers and fathers were within 5 years
    of age
  • 15.1 of the fathers were 5 years or more older
    than mother

13
Maternal and paternal adequacy of education for
Minnesota infants who died, 1990-1999, n 4302
  • Adequacy of education defined as at least high
    school completion for adults. For adolescents,
    an algorithm employing age and years completed
    used.
  • 81 of fathers had adequate educations
  • 64 of mothers had adequate educations

14
Maternal and paternal race for Minnesota infants
who died, 1990-1999, n 4302
  • 73 same
  • 4 different
  • 23 missing data
  • 66 parents both white
  • 7 both not white

15
Race of infant at birth and at death,1990-1999,
n 4302
16
Race coding of white infants
  • Of the 3440 whites at birth
  • 94.8 white at death
  • 2.4 black at death
  • 0.7 AI at death
  • 0.3 Asian at death
  • 1.8 missing
  • Of the 3362 whites at death
  • 97 white at birth
  • 1 missing at birth

17
Race coding of black infants
  • Of the 435 blacks at birth
  • 95.2 black at death
  • 2.8 white at death
  • 1.4 missing
  • Of the 513 blacks at death
  • 80.7 black at birth
  • 16.0 white at birth
  • 2.0missing

18
Race coding of American Indian infants
  • Of the 180 American Indians at birth
  • 81.7 Am Ind at death
  • 14.4 white at death
  • 2.0 black
  • 0.5 Asian
  • 1.7 missing
  • Of the 181 American Indians at death
  • 81.2 Am Ind at birth
  • 13.3 white at birth
  • 1.1 black at birth
  • 1.1 Asian at birth
  • 3.3 missing

19
Race coding of Asian infants
  • Of the 171 Asians at death
  • 91.2 Asian at birth
  • 6.4 white at birth
  • 0.5 each black and AI at birth
  • 1.2 missing
  • Of the 183 Asians at birth
  • 85.3 Asian at death
  • 9.8 white at death
  • 2.2 black at death
  • 1.1 AI at death
  • 1.6 missing

20
Deaths by birth and death race coding
21
Variables associated (Adjusted odds ratios and
95 C.I.s) with different infant races at birth
and death
  • Race of mother (compared with white)
  • Black OR 0.10 (0.05, 0.2)
  • Race of father (compared with white)
  • Black OR 49.8 (29.2, 85.3)
  • American Indian OR 15.1 (8.1, 27.1)
  • Asian OR 8.6 (4.8, 14.7)
  • Missing OR 22.1 (12.9, 38.7)

22
Variables associated (Adjusted odds ratios and
95 C.I.s) with different infant races at birth
and death
  • Age of mother (compared with older than 30 yrs)
  • 15-19 yrs OR 0.7 (0.5, 0.9)
  • Age of father (compared with older than 30 yrs)
  • 20-24 yrs OR 1.4 (0.9, 2.2)

23
Variables associated (Adjusted odds ratios and
95 C.I.s) with different infant races at birth
and death
  • Race of parents (compared with same)
  • Different OR 10.5 (7.2, 13.6)
  • Race missing, one or both OR 5.0 (3.2, 7.6)
  • Education of parents (compared with both
    adequate)
  • Education missing, one or both
    OR 0.6 (0.3, 0.9)

24
Variables not associated with racial coding
inconsistency
  • Low birthweight
  • Maternal tobacco use
  • Adequate prenatal care
  • Compared with white American Indian mother and
    Asian mother
  • Discordance in parental education
  • Discordance in parental age

25
So what?
  • Depending on whether race is coded by mother or
    at death will have different estimates of
    race-specific correlates of death

26
Correlates of death for black infants
  • If use maternal race, 7.7 of low birthweight
    infants, 5.1 of preterm infants, and 1.9 of
    infants born to teen mothers died
  • If use race at death, 12.0 of low birthweight
    infants, 5.7 of preterm infants, and 2.3 of
    infants born to teen mothers died

27
Correlates of death for American Indian infants
  • If use maternal race, 9.8 of low birthweight and
    4.2 of preterm infants died
  • If use race at death, 10.5 of low birthweight
    and 5.1 of preterm infants died

28
Summary
  • There were 18 more blacks at death than birth,
    7 fewer Asians, 1 more American Indians, and 2
    fewer whites
  • While inconsistency was found in both directions,
    in general, more infants were identified as
    non-white at death than they were at birth

29
Numbers at birth and death vs. inconsistent
coding of an individual
  • 82 of American Indians and 85 Asians were coded
    the same at birth and death
  • 95 blacks and 95 whites were coded the same on
    both records
  • Note In Minnesota Census 2000, 1/3 of American
    Indians also listed another race--most common
    among children

30
Conclusions and Limitations
  • It is not clear which certificate is valid for
    race
  • Tip of the iceberg only 1-2 of infants die,
    thus we dont know how stable the racial coding
    is for the majority who survived the first year
    of life
  • Inconsistencies on birth and death records
    provide more evidence that classifying race is
    difficult
  • Will allowing multiple race coding on vital
    records help or hinder enumerating race?
  • Would a more inclusive definition of social
    disparities, encompassing various measures of
    class, race, ethnicity, income, and geography,
    ultimately be more useful in serving
    disadvantaged individuals?
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