Abstract
Objective
Not all individuals self-identify with race categories on birth certificates, selecting “Other” and writing in identities. Our hypothesis was that curating write-in responses in the “Other” race category would contribute to understanding preterm birth inequities.
Methods
We analyzed Pennsylvania birth certificates (2006–2014). Two independent coders reviewed each write-in response among those who selected “Other” race. We compared preterm birth rates across subpopulations within “Other” race category using a Monte Carlo simulated Chi-square test.
Results
Among 1,196,125 singleton births, 72,891 (6.1%) exclusively selected “Other” race; Hispanic more often than non-Hispanic individuals (54.5% vs 0.7%), p < 0.0001). Only 545 (0.8%) of Hispanic individuals wrote in responses aligned with preestablished race categories compared to 2,601 (33.2%) of non-Hispanic individuals. Preterm birth rates varied significantly across identities within the “Other” group (P < 0.001).
Conclusion
Utilizing combinations of self-identified race, ethnicity, and continental origin may facilitate public health efforts focused on birth outcome equity.
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Data availability
Data is available from the Pennsylvania Health Care Cost Containment Council (PHC4, https://www.phc4.org/browse-our-data/).
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Funding
The time of BHC is supported by career development award NIH K08MH129657 and the time of DM-W is supported by career development award NIH K23HD102526.
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Contributions
KRH and HHB conceived of the study. KBH and AB reviewed each race written-in response. JR performed the analysis. BHC, DMH, AME participated in each study meeting, providing scientific guidance. KRH drafted the manuscript with mentorship from HHB. All authors reviewed, edited, and approved the final manuscript.
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The authors report no conflicts of interest and have no relevant financial disclosures. The Pennsylvania Health Care Cost Containment Council (PHC4) is an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of health care, and increasing access to health care for all citizens regardless of ability to pay. PHC4 has provided data to this entity in an effort to further PHC4’s mission of educating the public and containing health care costs in Pennsylvania. PHC4, its agents, and staff, have made no representation, guarantee, or warranty, express or implied, that the data – financial, patient, payor, and physician specific information – provided to this entity, are errorfree, or that the use of the data will avoid differences of opinion or interpretation. This analysis was not prepared by PHC4. This analysis was done by investigators at the Children’s Hospital of Philadelphia. PHC4, its agents and staff, bear no responsibility or liability for the results of the analysis, which are solely the opinion of this entity.
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Holloway, K.R., Radack, J., Barreto, A. et al. The “Other” race category on birth certificates and its impact on analyses of preterm birth inequity. J Perinatol 45, 372–377 (2025). https://doi.org/10.1038/s41372-024-02123-x
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DOI: https://doi.org/10.1038/s41372-024-02123-x
