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Avoiding loss of native individuals in birth certificate data

Journal of Perinatology volume 43, pages 385–386 (2023)Cite this article

Subjects

American Indian or Alaskan Native (AIAN) families are disproportionately affected by preterm birth compared to non-Hispanic White families (11.6 vs. 9.1% in 2020) [1]. Persistent inequities across the lifespan result in shorter life expectancies among AIAN individuals than any other racial group in the United States [2]. One challenge to improving health and healthcare of AIAN families is the lack of representation in research [3]. This is partly due to the small proportion of AIAN individuals in the US population (constituting roughly two percent). While the gold standard in analyses of racial disparities in health is to use self-identified race [4], advanced statistical models often cannot accommodate very small sample sizes [5]. As such, AIAN individuals often are absorbed into an “other” category when analyzing health outcomes, including preterm birth. Such aggregation can mask actionable disparities.

On the Pennsylvania (PA) birth certificate, there are two ways in which parents can indicate their race and ethnicity. Parents can check boxes and they can use a “write-in” option. The aim of this study was to determine whether using write-in data could meaningfully increase the sample size of AIAN populations in perinatal research. We used PA birth certificate data from 2006 to 2014, restricted to singleton births linked to hospital discharge data, to determine how many additional births among AIAN we could capture with examination of each write-in response. We then examined how preterm birth rates and their 95% confidence intervals differed among AIAN people when restricting to individuals who checked the AIAN box or when expanding to include write-in responses. Finally, we performed a power calculation to demonstrate the importance of increasing sample sizes to study relatively rare events such as preterm birth.

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Fig. 1: Statistical power to detect changes in preterm birth rate for cohorts of different sizes.

Data availability

Data used in in this study may be acquired from the Pennsylvania Vital Statistics Records office. We also welcome requests for analytic collaborations.

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Funding

Dr. Montoya-Williams was supported by the National Institutes of Health K23HD102526.

Author information

Authors and Affiliations

  1. University of Pennsylvania, Philadelphia, PA, USA

    Kayla Holloway

  2. Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Joshua Radack, Molly Passarella, Heather H. Burris & Diana Montoya-Williams

  3. Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Angela M. Ellison

  4. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Angela M. Ellison, Barbara H. Chaiyachati, Heather H. Burris & Diana Montoya-Williams

  5. Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Barbara H. Chaiyachati

  6. Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USA

    Barbara H. Chaiyachati, Heather H. Burris & Diana Montoya-Williams

Authors
  1. Kayla Holloway
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  2. Joshua Radack
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  3. Molly Passarella
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  4. Angela M. Ellison
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  5. Barbara H. Chaiyachati
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  6. Heather H. Burris
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  7. Diana Montoya-Williams
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Contributions

KH, DMW and HHB conceptualized of this study. AE and BC contributed to the design of the work. JR and MP acquired and analyzed the data. All authors contributed to the interpretation of the data. KH drafted the manuscript and all other authors critically revised the manuscript. All authors approve of the final version and agree to be accountable.

Corresponding author

Correspondence to Diana Montoya-Williams.

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The authors declare no competing interests.

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Holloway, K., Radack, J., Passarella, M. et al. Avoiding loss of native individuals in birth certificate data. J Perinatol 43, 385–386 (2023). https://doi.org/10.1038/s41372-022-01469-4

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  • DOI: https://doi.org/10.1038/s41372-022-01469-4

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