Birth Outcomes and Infant Mortality in Hawaii: Importance of Disaggregation of Data by Race and Ethnicity

Full Description: Aggregated race data obscures disparities in birth outcomes and infant mortality. Maternal and child health leaders and communities will not act to address disparities they can’t see. This abstract illustrates outcomes for publicly available data using Hawaii’s race categories as compared to standard OMB categories for selected birth outcomes and infant mortality. It contrasts findings that differ based on the use of aggregated versus disaggregated data and highlights the cultural, linguistic, environmental, and economic differences found within aggregated groups. These differences are associated with different health outcomes. Infant mortality (IM) is a widely accepted indicator of a population's overall health. IM in the USA is higher than in other developed nations, and rates differ substantially by racial subgroups underscoring the need for improvement. In recent years the infant mortality rate in Hawaii is rising with a slightly higher rate than the overall U.S. rates. Aggregated race categories- particularly among federally available data limit insights that may be gained and mask disparities. Hawaii's population is diverse. According to 2019 U.S. Census population estimates, 37.6 percent of Hawaii residents are Asian, 21.7 percent are white, 10.1 percent are Native Hawaiian and Other Pacific Islander by themselves, and 24.2 percent identify as having two or more races. Filipinos, Japanese, Chinese, Koreans, Vietnamese, and other Asians are among the many ethnic groups represented in the Asian race subgroup. The NHOPI category includes Native Hawaiians, Samoans, Marshallese, Guamanian or Chamorro, Tongans, and Other Pacific Islanders. Often, Asian, Native Hawaiian, and Pacific Islander data are grouped together under the umbrella term "AAPI – Asian American and Pacific Islander" or headings "Asians'' and "Native Hawaiian and Pacific Islander" (NHOPI). Among these populations, there are variations in cultural practices, language, and social and economic experiences that influence health outcomes. With aggregated data, it is difficult to see the disparities affecting subgroups among Hawaii's diverse population. These challenges occur in other states with diverse populations. Further, common MCH data resources report outcomes using different race categories masking disparities and confusing the community providers and constituents. For example, March of Dimes reports aggregated Asian and Pacific Islander IMR of 6.2 (2016-2018). Yet, disaggregated data for the same years yields an IMR of 7.3 Native Hawaiian, 7.2 Filipino, 3.7 Japanese, 6.6 Chinese, 10.8 Samoan, 9.0 Other Pacific Islander, 3.1 Other Asian (HDOH, OHSM). This presentation will highlight differences across commonly accessed MCH data sources and make recommendations on strategies to address differences. Recommendations include disaggregating racial data and increasing sample sizes in communities with diverse populations to better inform culturally responsive health interventions.

Abbreviated Description: Disaggregation of data by race and ethnicity is essential to identifying health disparities across birth outcomes and to inform program planning and implementation to advance health equity. Aggregated data obscures specific health disparities. Disaggregating racial data and increasing sample sizes in diverse communities are necessary to promote culturally responsive health interventions and meet health equity goals.