O2075: Disparities in Breastmilk Use at Discharge Among Asian American, Native Hawaiian, and Pacific Islander Very Low Birth Weight Infants in California

Background: Data aggregation of Asian American, Native Hawaiian & Pacific Islanders (AANHPI) obscures disparities and opportunities to provide equitable care. Previous descriptive analysis demonstrates variability in breastmilk use at discharge amongst AANHPI very low birth weight (VLBW) infants in California. We aim to describe the association of disaggregated AANHPI racial/ethnic VLBW infants and breastmilk use at discharge in California.

Methods: This is a cohort of 6,534 mother-infant dyads from the California Perinatal Quality Care Collaborative/Vital Statistics linked data registry for AANHPI VLBW infants (22-29 weeks estimated gestational age or birth weight 401-1500 grams), born 2011-2019, based on maternal self-reported race. Race/ethnicity groups were Chinese, Japanese, Korean, Asian Indian, Laotian/Thai/Hmong/Cambodian, Vietnamese, Filipino, Other specified or unspecified Asian, Asian multiple, Asian and non-Asian multiple, native Hawaiian, and Other Pacific Islander. We excluded infants who died within 12 hours of life. We examined unadjusted odds of breastmilk use at discharge compared to non-Hispanic White (NHW) VLBW infants; NHW infants were the reference group for comparability to the extant literature, which does not imply a standard. We then performed hierarchical, step-wise regression including infant (sex, birth weight, weight for gestational age, inborn/outborn, mode of delivery, multiple birth, and 5-minute APGAR score), maternal (education, country of origin, tobacco use, insurance), and hospital-level factors (AAP level, hospital ownership, VLBW volume).

Results: Table 1 describes the cohort of AANHPI mothers and infants. Laotian/Thai/Hmong/Cambodian and Pacific Islander mothers received less education (42% and 47% less than high school education, respectively) and higher Medical use (49% and 48%, respectively). Unadjusted breastmilk use at discharge demonstrates wide variability: Pacific Islander infants were the least likely to receive breastmilk at discharge (57%) compared to East and South Asian infants (Chinese 83%; Japanese 87%; Korean 87%, Indian 85%). Figure 1 shows unadjusted and adjusted odds ratios (ORs) of receiving breastmilk at discharge compared to NHW infants. In the unadjusted model, Chinese (OR 1.8, confidence interval 1.5-2.1), Japanese (2.3, 1.4-3.9), Korean (2.3, 1.6-3.5), Indian (2.0, 1.7-2.4), and Vietnamese (1.5, 1.1-1.9) infants were significantly more likely to receive breastmilk at discharge compared to NHW infants. Laotian/Thai/Hmong/Cambodian (0.6, 0.5-0.8) and Pacific Islander (0.5, 0.4-0.6) infants were significantly less likely. After adjusting for infant, maternal, and hospital-level factors, the effect was attenuated: Indian (1.4, 1.1-1.7) and Vietnamese (1.5, 1.1-1.9) were more likely to receive breastmilk, and Pacific Islander (0.6, 0.5-0.8) were less likely.

Conclusion: Data disaggregation demonstrates substantial variability in breastmilk use at discharge among AANHPI VLBW infants. Pacific Islander infants are less likely to receive breastmilk at discharge. Quality improvement interventions should address barriers to breastmilk feeding in this population.