The infant mortality rate in the United States has undergone dramatic decreases in the past two decades, declining by 40% since 1980. Despite these tremendous gains in infant survival, large racial disparities exist, particularly between black and white infants. The black infant mortality rate is 2.4 times as high as that of white. This large racial disparity is a major public policy concern and has led the President to identify infant mortality as one of six areas to be targeted i order to reduce racial disparities in health in the United States. In this project, we focus on racial and ethnic differences in access to care among high-risk infants. Specifically, we will address the following questions: What is the extent of racial and ethnic differences in access to high quality and high-level NICU services? Which factors are mutable and thus amenable to policy interventions that could reduce the racial gap in infant mortality in the United States? The project will use linked birth, records, death records and hospital discharge abstract data for all births in the state of California for the years 1999-2000. The provision of NICU care has undergone large changes in recent years, with a shift away from the regionalization of services in high-level NICUs to the provision of care in an ever-increasing number of lower-level NICUs, with largely unknown consequences of the quality of patient care. California has been at the forefront of this provider shift, as well as to the large shift in the receipt of health insurance coverage through managed care plans. The state is ethnically diverse, with the largest number of Hispanic and Asian births and ranking fifth in the number of black births, thus providing a fertile ground for studying the proposed relationships.
| Calderón, José Luis; Bazargan, Mohsen; Sangasubana, Nisaratana et al. (2010) A comparison of two educational methods on immigrant Latinas breast cancer knowledge and screening behaviors. J Health Care Poor Underserved 21:76-90 |
| Tobias, Carol; Cunningham, William E; Cunningham, Chinazo O et al. (2007) Making the connection: the importance of engagement and retention in HIV medical care. AIDS Patient Care STDS 21 Suppl 1:S3-8 |
| Rumptz, Maureen H; Tobias, Carol; Rajabiun, Serena et al. (2007) Factors associated with engaging socially marginalized HIV-positive persons in primary care. AIDS Patient Care STDS 21 Suppl 1:S30-9 |
| Calderon, Jose L; Baker, Richard S; Fabrega, Horacio et al. (2006) An ethno-medical perspective on research participation: a qualitative pilot study. MedGenMed 8:23 |
| Morales, Leo S; Staiger, Douglas; Horbar, Jeffrey D et al. (2005) Mortality among very low-birthweight infants in hospitals serving minority populations. Am J Public Health 95:2206-12 |
| Wong, Mitchell D; Tagawa, Tomoko; Hsieh, Hsin-Ju et al. (2005) Differences in cause-specific mortality between Latino and white adults. Med Care 43:1058-62 |
| Calderon, Jose L; Shaheen, Magda; Pan, Deyu et al. (2005) Multi-cultural surveillance for ectopic pregnancy: California 1991-2000. Ethn Dis 15:S5-20-4 |
| Rogowski, Jeannette A; Staiger, Douglas O; Horbar, Jeffrey D (2004) Variations in the quality of care for very-low-birthweight infants: implications for policy. Health Aff (Millwood) 23:88-97 |
| Calderon, Jose Luis; Zadshir, Ashraf; Norris, Keith (2004) A survey of kidney disease and risk-factor information on the World Wide Web. MedGenMed 6:3 |
| Calderon, Jose Luis; Zadshir, Ashraf; Norris, Keith (2004) Structure and content of chronic kidney disease information on the World Wide Web: barriers to public understanding of a pandemic. Nephrol News Issues 18:76, 78-9, 81-4 |
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