MULTI-CULTURAL SURVEILLANCE FOR ECTOPIC PREGNANCY:CALIFORNIA 1991–2000 Background: National surveillance for ectopic pregnancy (EP), the primary cause of maternal death in the first trimester, began in 1970. EP rates peeked during the late 1980s and have been highest for African Americans. However, limited reports on EP rates exist for other racial/ ethnic groups. Objectives: To report state-level, multicultural trends in EP rates from 1991 to 2000. Methods: Secondary data analysis of the California hospital discharge database collect- ed by the Office of Statewide Health Planning and Development by using codes 633.0– 633.9, from the International Classification of Diseases, Ninth Revision. EP rates are reported per 1000 pregnancies. Results: From 1991 to 2000, 62,839 EP were reported in California. Mean EP rate was 11.2/ 1000, decreased from 15/1000 to 9.3/1000, and varied significantly by race/ethnicity and age. EP rates were highest among African Americans (25/1000) and lowest among His- panics (7.7/1000); African Americans had higher odds of having EP relative to non- Hispanic Whites (odds ratio [OR] 2.14, 95% confidence interval [CI] 2.09–2.19). Women 35–44 years of age had the highest EP rates (17.6/1000) and higher odds of having EP compared to other age groups (OR 2.45, 95% CI 2.39–2.50). The highest rate of EP was found among African Americans 35–44 years of age (43.1/1000). Conclusions: The study showed declining EP rates in California for all groups but highlights disparities in EP rates and the attenuated rate of decline for African Americans, which places them at highest risk of death in the first trimester. This study demonstrates the useful- ness of analyzing state-level data that may differ from aggregated national data when studying culturally diverse populations. (Ethn Dis. 2005;15 [suppl 5]:S5-20–S5-24) Key Words: Multi-Cultural, Ectopic Pregnan- cy, Health Disparities, Women’s Health Jose L. Caldero ´n, MD; Magda Shaheen, MD; Deyu Pan, MS; Senait Teklehaimenot, MPH; Paul L. Robinson, PhD; Richard S. Baker, MD INTRODUCTION In 1970, the Center for Disease Control initiated its national surveil- lance for ectopic pregnancy (EP), the primary cause of maternal death in the first trimester. 1 This surveillance showed that EP rates reached their peak in the 1980s, leveled off by 1992, and have declined steadily since. 2,3 Similar trends have been noted in other in- dustrialized nations. 4,5 Paradoxically, during the 20-year period that saw rates of EP rise to epidemic proportions in the 1980s, morbidity and mortality from EP declined. This inverse relation- ship was attributed to improved radio- logic and serologic diagnostic proce- dures that allowed early detection and timely use of medical intervention with intramuscular methotrexate and less invasive laparoscopic surgery. 6,7 Since nearly half of EPs are due to sexually transmitted diseases, especially inflamation and scarring of fallopian tubes with Chlamydia trachomatis, some epidemiologists suggest that EP may be a proxy indicator of sexually transmitted disease that has a higher incidence among minorities. 8–10 Other indepen- dent risk factors include previous EP, previous pelvic surgery, smoking, endo- metriosis, and use of contraceptive devices. 11–14 Most of these risk factors are disparately higher among African Americans, which correlates with the CDC surveillance findings that African- American women have consistently had higher EP rates and higher mortality from EP when compared to non- Hispanic Whites. 1–3 Despite the drop in national EP rates, we do not know which popula- tions experience the benefits of these changes, since epidemiologic surveil- lance for EP at the national level has traditionally aggregated rates into three categories: Whites, African Americans, and others. This categorization has several implications. The Hispanic and Asian populations have the fastest rate of growth and the highest rate of immigration, which has powered signif- icant demographic shifts and increased diversity nationally, particularly in the most populous states and urban areas. Aggregating health-related data for di- verse minority populations as ‘‘others,’’ especially when this group includes Hispanics, who represent the largest minority group, may mean that the conclusions reached in the analysis of these data do not accurately portray the incidence of phenomena such as EP. In addition, reporting these data as part of national trends may not accurately reflect the epidemiology of disease in highly populous and diverse states such as California. Despite a declining trend in the rate of EP in industrialized nations, the rate of EP in developing nations has risen. The common denominator among these nations is poverty, higher rates of sexually transmitted diseases, and di- minished access to care, especially in Africa. 15 These three characteristics are germane to African Americans. More- over, other than for African Americans, little information about EP exists for racial/ethnic minority groups, particu- larly Hispanics and Asians, and to date no multicultural studies of EP rates have been reported. The purpose of this study was to evaluate state-level multi- cultural trends in ectopic pregnancy rates in California during the 10-year period from 1991 to 2000. RCMI-Biomedical Research Center, Drew University Center for Cross-cultural Epidemiologic Studies: Women’s Health Initiative Projects, The Charles R. Drew University of Medicine & Science, Los Angeles, California. Address correspondence and reprint requests to Jose´ Luı ´s Caldero ´n, MD, 2594 Industry Way; Lynwood, CA 90262. 760-521-5511; 310-631-1495 (fax); drcalderon@sbcglobal.net S5-20 Ethnicity & Disease, Volume 15, Autumn 2005