621 - Neonatal Mortality Rates Across Asian American, Native Hawaiian, and Pacific Islander Populations (2015-2019)

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 621
Publication Number: 621.14

Isabelle Maricar, Stanford University School of Medicine, Dunn Loring, VA, United States; Daniel Helkey, Stanford University School of Medicine, Palo Alto, CA, United States; Santhosh Nadarajah, Princeton University, Cerritos, CA, United States; Risa Akiba, University of Chicago, Chicago, IL, United States; Adrian M. Bacong, Stanford University School of Medicine, Mountain View, CA, United States; Sheila Razdan, Stanford University School of Medicine, Palo Alto, CA, United States; Ciaran S. Phibbs, Stanford University School of Medicine, Stanford, CA, United States; Jochen Profit, Stanford University School of Medicine, Palo Alto, CA, United States

Presenting Author(s)

Isabelle Maricar (she/her/hers)

Research Scholar
Stanford University School of Medicine
Dunn Loring, Virginia, United States

Background: In aggregate, Asian American, Native Hawaiian, and Pacific Islander (AANHPI) newborns have the lowest neonatal mortality rate (NMR) compared with other racial/ethnic groups. However, this group is highly heterogeneous and this may obscure within-group disparities. Few studies have explored disaggregated AANHPI neonatal outcomes.

Objective: Compare neonatal mortality (< 28 days) rates across disaggregated AANHPI groups with other racial/ethnic groups using non-Hispanic (NH) White neonates as a reference group based on the extant literature.

Design/Methods: We examined all infants born from 2015-2019 using birth certificates linked to infant death certificates from the National Vitals Statistics System (N=19,367,404). We disaggregated AANHPI births and neonatal deaths (n=3,732) into the following groups: Chinese, Japanese, Korean, Filipino, Vietnamese, Indian, Other Asian, Native Hawaiian, Guamanian, Samoan, and Other Pacific Islander. We calculated crude NMRs for AANHPI groups and for NH White, NH Black, American Indian/Alaskan Native, Hispanic, and Multiple Race neonates. We used multivariate logistic regression to examine differences in NMRs across racial/ethnic groups (reference group, NH White) after adjusting for maternal sociodemographic, clinical, and neonatal risk factors. For this analysis, we collapsed Native Hawaiian and all Pacific Islander (NHPI) groups into a single racial/ethnic category due to sample size.

Results: Compared to the average NMR (deaths per 1000 live births) of 3.8 and the NH White NMR of 3.1, the crude AANHPI NMR was lower, 2.9. However, disaggregated NMRs ranged from 1.7 among Chinese neonates to 5.7 among Samoan infants (Table 1). Table 1 also shows large variability in the maternal sociodemographic, clinical, and neonatal risk factors across AANHPI groups. Figure 1 shows the considerable variance across groups after risk adjustment. East Asian neonates (Chinese, Japanese, Korean) had lower likelihoods of mortality for all three regression models. Indian, Filipino, and Vietnamese infants initially had higher likelihoods of mortality after adjusting for maternal sociodemographic and clinical factors but had lower likelihoods after additionally accounting for neonatal risk factors. NHPI neonates were the only group with a higher mortality likelihood after full risk adjustment.

Conclusion(s): Large variability in crude and risk-adjusted NMRs across AANHPI groups emphasizes the importance of disaggregating this widely diverse population. Our findings highlight potential opportunities for improvement.