Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Zeyan Liew

Abstract

Background: Cerebral palsy (CP) affects approximately 3 out of 1000 children in the United States (U.S.),1 and while previous studies have shown significant racial disparities in CP outcomes, the Hispanic population is understudied despite it being the fastest growing minority group in the U.S. The Hispanic population is also of interest because of data showing poorer health outcomes in cancer, neonatal morbidity, and other perinatal outcomes among U.S.-born Hispanic women compared to their foreign-born counterparts. Thus, this analysis aimed to investigate whether incidence of CP in Hispanic women’s offspring differed by the mother’s birthplace. Methods: Linked California birth certificate and California Department of Developmental Services (DDS) records between 2000-2015 were used for this analysis. All non-Hispanic mothers were excluded from the main analysis, resulting in a cohort of 4,233,966 births containing 5,476 CP cases. A sub-analysis of only Mexican mothers included 3,514,470 births and 4,515 CP cases. Multivariable logistic regression models adjusted for sex, birth year, mother’s age and education, father’s age, trimester of prenatal care onset, parity, and multiple births were used to estimate odds ratios (ORs) for CP diagnosis by maternal nativity. Stratification analysis was performed for child’s sex, CP subtype and CP location. Results: CP was 12% more likely to occur in the offspring of U.S.-born Hispanic mothers compared with the offspring of foreign-born Hispanic mothers (OR = 1.12; 95% CI: 1.05 – 1.19). Similar results were found for Mexican mothers (OR = 1.13; 95% CI: 1.05 – 1.21) where odds of CP diagnosis was greater among U.S. born mothers. Stratification showed that this increased likelihood was greater in unilateral CP over bilateral CP and stronger among female offspring than male offspring. Lastly, increased odds of CP diagnosis in offspring of U.S.-born mothers was only present in the spastic CP type. Conclusions: In line with previous research into other health outcomes, CP was more likely to be diagnosed in the offspring of Hispanic women born in the U.S. compared to offspring of foreign-born Hispanic women. This adds CP to the list of poorer pregnancy-related outcomes among Hispanic women born in the U.S. Future policymakers and investigators working with Hispanic populations should carefully consider how mothers’ nativity might influence policy impacts and developmental disorder outcomes, especially for neurological disorders such as CP.

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This is an Open Access Thesis.

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