RACIAL-ETHNIC DIFFERENCES IN PRENATAL DIAGNOSTIC-TEST USE AND OUTCOMES - PREFERENCES, SOCIOECONOMICS, OR PATIENT KNOWLEDGE

Objective: To determine whether use of chorionic villus sampling and a mniocentesis varies by racial-ethnic group and, if so, whether this va riation is reflected in the prevalence of Down syndrome-affected birth s to women age 35 and older, the ages at which prenatal diagnosis is o ffered currently. Methods: Medical charts of 238 women 35 years of age and older presenting for care at the University of California at San Francisco by 20 gestational weeks in 1993 and 1994 were reviewed to as sess prenatal diagnostic test use. The prevalence of Down syndrome-aff ected births in California during 1983-1991 was obtained from the Birt h Defects Monitoring Program. Results: Latinas and African-American wo men were much less likely to undergo prenatal diagnosis than were whit es and Asians. Odds ratios (OR) and 95% confidence intervals (CI), wit h white women serving as the reference group, were as follows: Asians 1.16 (0.57-2.36), Latinas 0.19 (0.08-0.43), and African-Americans 0.19 (0.07-0.49). Trends persisted, at diminished magnitude, after adjustm ent for socioeconomic characteristics: OR for Asians 1.77 (0.78-3.98), Latinas 0.28 (0.09-0.83), and African-Americans 0.33 (0.10-1.10). Non -white women age 35 and older were significantly more likely than whit e women to give birth to a Down syndrome-affected infant: risk ratios for Asians 1.81 (1.61-2.03), Latinas 3.00 (2.74-3.28), and African-Ame ricans 1.86 (1.63-2.11). Conclusion: Racial-ethnic differences exist i n prenatal diagnostic test use and associated outcomes in women age 35 and older. Socioeconomic factors are partially responsible; patient e ducation and preferences may play a role.