Health Disparities
Birth outcomes and pregnancy complications among US service members by disaggregated Asian, Native Hawaiian and Pacific Islander, and American Indian and Alaska Native race and ethnicity, 2010–2021 Celeste Romano* Celeste Romano Clinton Hall Monica Burrell Anna Bukowinski Jackielyn Lanning Sandra Maduforo Sandra Michelle Magallon Zeina Khodr Gia Gumbs Ava Marie Conlin
Introduction: A dearth of health disparities research has disaggregated data for US service members identifying as Asian and Native Hawaiian and Pacific Islander (NHPI) or reported health outcomes for racial and ethnic subgroups. Group representation is also underestimated when restricting group counts to those identifying as single race and non-Hispanic, especially for American Indian and Alaska Native (AIAN) and NHPI populations. Disaggregated estimates of health outcomes are needed to illuminate the experiences of military members identifying as Multiracial and Native and to elucidate patterns indiscernible in aggregated data.
Methods: Live births among pregnant service members were captured in Department of Defense Birth and Infant Health Research program data, 2010–2021. Self-reported race and ethnicity were obtained from personnel records. The prevalence of select birth outcomes and pregnancy complications, identified from medical encounter data, were calculated by disaggregated race and ethnicity.
Results: Overall, 216,017 births were identified among pregnant US service members and an increasing proportion occurred among Asian and Multiracial service members. Adverse birth outcomes and pregnancy complications varied in prevalence across racial and ethnic groups, particularly across Asian subgroups: Asian Indian and Filipino service members had consistently higher rates of adverse outcomes compared with other Asian subgroups and the total Asian population (eg, cesarean birth: 37.3% Asian Indian, 33.2% Filipino, 28.6% Asian). Multiracial AIAN and NHPI service members had higher rates of select adverse outcomes than their single-race, non-Hispanic counterparts (eg, low birth weight: 4.4 vs 3.8% AIAN; 4.9 vs 4.1% NHPI).
Conclusions: Increased attention should be paid to the disaggregation of racial and ethnic health outcomes among service members, especially given recognized disparities among racial and ethnic subgroups and the Multiracial population.