PC1067: Going Beyond the "Model Minority": A Descriptive Analysis of Outcomes in Asian American, Native Hawaiian, and Pacific Islander Very Low Birth Weight Infants in California

Background: The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population is a highly heterogeneous group, representing people from over 30 countries, with variability in cultural practices, languages, and health care experiences. Aggregation of data from this diverse group may obscure opportunities to provide more equitable care. This study describes maternal characteristics and infant care processes and outcomes across the AANHPI very low birth weight (VLBW) population in California.

Methods: We queried the California Perinatal Quality Care Collaborative/vital statistics linked data registry for AANHPI infants (based on mother’s self-identified race) of 22-29 weeks estimated gestational age or with birth weight of 401-1500 grams, who were born between 2011 and 2019. We excluded infants who died in the delivery room or within the first 12 hours of life. Quality of care was measured using the components of Baby-MONITOR, a composite of process and outcome measures. For each measure, we calculated proportions and measures of centrality as appropriate.

Results: In this VLBW sample, we find substantial heterogeneity in maternal risk and neonatal outcomes across the various AANHPI populations. Table 1 describes the cohort of the AANHPI mother-infant dyads. With regard to maternal factors, the most notable variability was in place of birth: 9% of Asian Indians were born in the United States compared to 88% of multiracial women who identified as Asian and at least one non-Asian race. Compared to the other groups, Other Pacific Islander mothers had the lowest levels of educational attainment (11% Bachelors’ or higher) and highest proportion of Medi-Cal use (48%). With regards to infant factors, the Other Pacific Islander infants had the lowest mean gestational age (28 weeks 6 days) and the highest proportion of low APGAR scores (10%). Being small for gestational age was most common among Asian Indian babies (43%). Table 2 demonstrates the unadjusted Baby-MONITOR outcomes across the groups. The Other Pacific Islander population had the lowest proportion of breastmilk use at discharge (57%), highest hypothermia percentage (11%), highest hospital-acquired infections (9%), and the highest mortality (10%). Some discordance exists between process and outcome measures: while some groups (Asian Indian and Japanese) had better process and outcome measures, the Korean group scored best on many process measures (breast milk use, antenatal steroids, and timely eye exam) but worst on others (chronic lung disease and pneumothorax).

Conclusion: Substantial variability exists across AANHPI sub groups. The Other Pacific Islander group experiences clinical challenges deserving of additional attention.