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Neonatal mortality among disaggregated Asian American and Native Hawaiian/Pacific Islander populations

Journal of Perinatology volume 45, pages 1520–1527 (2025)Cite this article

Subjects

Abstract

Objective

We compared neonatal (<28 days) mortality rates (NMRs) across disaggregated Asian American and Native Hawaiian/Pacific Islander (AANHPI) groups using recent, national data.

Study design

We used 2015–2019 cohort-linked birth-infant death records from the National Vital Statistics System. Our sample included 61,703 neonatal deaths among 18,709,743 births across all racial and ethnic groups. We compared unadjusted NMRs across disaggregated AANHPI groups, then compared NMRs adjusting for maternal sociodemographic, maternal clinical, and neonatal risk factors.

Results

Unadjusted NMRs differed by over 3-fold amongst disaggregated AANHPI groups. Native Hawaiian/Pacific Islander neonates in aggregate had the highest fully-adjusted odds of mortality (OR: 1.08 [95% CI: 0.89, 1.31]) compared to non-Hispanic White neonates. Filipino, Asian Indian, and Other Asian neonates experienced significant decreases in odds ratios after adjusting for neonatal risk factors.

Conclusion

Aggregating AANHPI neonates masks large heterogeneity and undermines opportunities to provide targeted care to higher-risk groups.

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Fig. 1: Adjusted neonatal mortality by race and ethnicity.

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Data availability

Data for this study is publicly available through the National Vitals Statistics System.

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Acknowledgements

The authors would like to thank the Stanford Center for Asian Health Research and Education for their support of this study.

Funding

Unrestricted funding was provided through the Stanford Center for Asian Health Research and Education and Chi-Li Pao Foundation. This study was also in part supported by funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development R01HD103662, Profit J and Main E, co-PIs; and the National Heart, Lung, and Blood Institute 1K24HL150476, Palaniappan L, PI.

Author information

Author notes

  1. These authors contributed equally: Ciaran S. Phibbs, Jochen Profit.

Authors and Affiliations

  1. Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA

    Isabelle Nguyên Ý Maricar, Santhosh Nadarajah, Risa Akiba, Adrian Matias Bacong & Latha Palaniappan

  2. Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA

    Isabelle Nguyên Ý Maricar

  3. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA

    Daniel Helkey, Sheila Razdan, Ciaran S. Phibbs & Jochen Profit

  4. California Perinatal Quality Care Collaborative, Palo Alto, CA, USA

    Daniel Helkey & Jochen Profit

  5. Department of Molecular Biology, Princeton University, Princeton, NJ, USA

    Santhosh Nadarajah

  6. Department of Statistics, University of Chicago, Chicago, IL, USA

    Risa Akiba

  7. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Adrian Matias Bacong & Latha Palaniappan

  8. Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

    Ciaran S. Phibbs

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  1. Isabelle Nguyên Ý Maricar
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Contributions

Isabelle Maricar drafted the initial manuscript, coordinated research group meetings, and critically reviewed and revised the manuscript. Santhosh Nadarajah and Risa Akiba drafted the initial manuscript, and critically reviewed and revised the manuscript. Daniel Helkey prepared the study’s data, carried out the analyses, and critically reviewed and revised the manuscript. Adrian Bacong, Sheila Razdan, and Latha Palaniappan critically reviewed and revised the manuscript for important intellectual content. Ciaran Phibbs and Jochen Profit conceptualized and designed the study, supervised the research group and manuscript progress, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Isabelle Nguyên Ý Maricar.

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Competing interests

The authors declare no competing interests. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.

Ethics approval and consent to participate

This study was deemed exempt by Institutional Board Review by the Stanford University School of Medicine as data are publicly available and de-identified by the National Vitals Statistics System. Thus, this study was also conducted in accordance with the Declaration of Helsinki.

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Maricar, I.N.Ý., Helkey, D., Nadarajah, S. et al. Neonatal mortality among disaggregated Asian American and Native Hawaiian/Pacific Islander populations. J Perinatol 45, 1520–1527 (2025). https://doi.org/10.1038/s41372-024-02149-1

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