A Good Start in Life

Revisiting Racial and Ethnic Disparities in Health Outcomes At and After Birth

by Sai Ma

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Intergroup differences in health can reflect on and result in unequal life opportunities. In particular, racial and ethnic disparities in birth outcomes have long been a concern for both researchers and policy makers. Differences in health at birth are especially critical because they may lead to disparities in health as well as socioeconomic conditions throughout one’s whole life. This dissertation contributes to three aspects of the existing literature regarding race/ethnicity and birth outcomes: First, it uses a propensity scoring estimation method to reassess the differences in birth outcomes across racial/ethnic groups. The result suggests the use of OLS may not be a practical concern, although propensity score estimation shows its own advantages and thus should be used as sensitivity analysis to complement OLS. Second, an examination of biracial infants shows that father’s race and ethnicity are relatively unimportant, but the presence of unreported fathers has a strong association with birth outcomes, which might be a source of bias in existing data, and a significant signal of potential post-birth health problems. Finally, this research investigates the competing power of different birth outcome measures as predictors of infant mortality. The results show that the importance of risk factors and birth outcome measures varies by race/ethnicity, gender, and time, which suggests a need to tailor prevention and education efforts, especially during the postneonatal period. These results, taken in combination, lead to the conclusion that policy makers need to not only continue focusing on closing the recognized gap between black and other racial/ethnic groups in birth outcomes, but also pay more attention to subpopulations that are traditionally not considered as at risk and certain time periods that are previously regarded as less risky.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Revisiting the racial and ethnic disparities in birth outcomes

  • Chapter Three

    Racial/ethnic disparities in health outcomes of biracial infants

  • Chapter Four

    Associations between birth outcome measures and infant mortality at different time periods

  • Chapter Five

    Conclusions: research and policy implications

Research conducted by

This document was submitted as a dissertation in March 2007 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of Brian K. Finch (Chair), M. Rebecca Kilburn, and Julie DaVanzo.

This report is part of the RAND Corporation dissertation series. Pardee RAND dissertations are produced by graduate fellows of the Pardee RAND Graduate School, the world's leading producer of Ph.D.'s in policy analysis. The dissertations are supervised, reviewed, and approved by a Pardee RAND faculty committee overseeing each dissertation.

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