Blog Post

A Preterm Birth Study by LDI Fellows Supports Newly Instituted Changes to Racial and Ethnic Categorizations by a Key U.S. Agency

The Changes Aim to Better Capture Peoples’ True Identities on Birth Certificates

January 22, 2025

By:

Kayla Holloway

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Racial disparities in birth outcomes, especially preterm birth, remain an urgent example of racial inequity in the U.S. health system. Non-Hispanic Black infants are three times more likely to be born preterm than their non-Hispanic White counterparts. Despite how well-documented this problem is, flaws in recording and analyzing racial identity make addressing these inequities challenging for researchers and policymakers.

Interventions aimed at correcting disparities rely on racial and ethnic data from vital statistics records like birth certificates. However, the standard race categories on these records often fail to depict the nuances of individual identities. When people select the “Other” race category as a default to these categories, the broad designation limits the ability to gather meaningful data about health outcomes for these populations.

A study by Summer Undergraduate Mentored Research Program (SUMR) alumna Alejandra Barreto, LDI Senior Fellows Heather H. Burris, Diana Montoya Williams, and Barbara H. Chaiyachati, and me investigated the “Other” race category on birth certificates to see how this category could affect reporting of preterm birth inequities. Using millions of Pennsylvania birth certificates from 2006 to 2014, the team analyzed the 6.1% of birth certificates that had the “Other” race designation accompanied by a patient-provided write-in response.

Our team discovered that recategorizing the “Other” category based on combinations of race, ethnicity, and geographic origin revealed overlooked disparities. For example, substantial changes to preterm birth rates were observed in the Hispanic Asian and non-Hispanic Alaskan Indian and American Indian groups. Moreover, new groupings that further broke down the “Other” category allowed for more accurate insight into how preterm birth risk varies among marginalized groups.

Adding individuals who otherwise would not have been counted in preterm birth risk assessment analyses increased group numbers among minority populations and allowed for a more holistic analysis. For instance, we found that 54% of Hispanic individuals chose “Other” and then wrote in Latino or Hispanic, suggesting that Hispanic birthing people in Pennsylvania often did not identify with the racial options provided.

The findings of our study about the “Other” category are in line with new two changes instituted by the U.S. Office of Management and Budget (OMB). The OMB created a Middle Eastern and North African (MENA) category, and it created a combined Hispanic race and ethnicity category. Combining race and ethnicity into one question so individuals can select “Hispanic” as a standalone response should help reduce the number of Hispanic individuals who are overlooked in the “Other” category.

However, one risk our study points out is that the new Hispanic category risks masking ongoing racial inequities within the Hispanic group. This is because, within the Hispanic group, there are higher rates of preterm birth amongst Hispanic American Indian Alaskan Native and Hispanic Black populations than among White Hispanic populations. In addition, the majority of the non-Hispanic individuals in the “Other” category identified with Middle Eastern or North African (MENA) origins. While the OMB’s addition of MENA promises to be a useful category for birthing people in Pennsylvania, it too may mask inequities within this diverse region of origin.

Beyond the OMB’s updates, our study demonstrates that adding additional nuances to the “Other” category can capture other often overlooked identities, such as American Indian and Alaskan Native (AIAN). As a commonly underrepresented demographic in health research, the AIAN group is often a challenge to analyze since they tend to have small sample sizes. By recategorizing the patients who selected the “Other” category and wrote in AIAN, our study was able to increase the sample size of births from AIAN families by 24.5%, revealing again the importance of disaggregating the Other category.

By showing the impact of analyzing written-in responses to the race question, our study shows how considering combinations of self-identified race, ethnicity, and continental origin could meaningfully improve public health efforts focused on birth outcome equity. Vital statistics agencies and researchers should consider curating race designation data using automated methods, with human checking for accuracy, to ensure that the “Other” category is adequately analyzed and considered in the quest for birth outcome equity — and other efforts to achieve health equity.

The study, “The “Other” Race Category on Birth Certificates and its Impact on Analyses of Preterm Birth Inequity,” was published on September 24th, 2024 in Journal of Perinatology. Authors include Kayla R. Holloway, Alejandra Barreto, Barbara H. Chaiyachati, Diana Montoya-Williams, and Heather H. Burris.