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Poster Session 1

Category: Epidemiology

Poster Session 1

(186) Geographic and Demographic Risk Factors for Stillbirth in Hawai’i

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Submitting Author(s)

Elizabeth Mercer, MD, MS (she/her/hers)

MFM Fellow
University of Hawaii
Honolulu, Hawaii, United States

Coauthor(s)

KI

Kyle M. Ishikawa, MS

Biostatistical Analyst
University of Hawaii
Honolulu, Hawaii, United States
AB

April Binari, MBA

Healthcare Project Manager
University of Hawaii
Honolulu, Hawaii, United States
AG

Ashley Graham

Project Director
Pacific Basin Telehealth Resource Center
Honolulu, Hawaii, United States
Corrie Miller, DO

Assistant Professor
University of Hawaii
Honolulu, Hawaii, United States

Presenting Author(s)

Hyeong Jun Ahn, PhD

Associate Professor
University of Hawaii John A Burns School of Medicine Department of Quantitative Health Sciences
Honolulu, Hawaii, United States

Coauthor(s)

Men-Jean Lee, MD (she/her/hers)

Associate Chair
University of Hawaii
Honolulu, Hawaii, United States

Objective:
Stillbirth disproportionately affects Native Hawaiian and Pacific Islander (NHPI) populations in Hawai‘i. While statewide rates are known, maternal risk factors and geographic variability remain unclear. We aimed to identify demographic and geographic predictors of stillbirth in Hawai‘i, including maternal age, ethnicity, English proficiency, and travel burden to the delivery location.

Study Design:
We conducted a retrospective cohort study using Hawai‘i birth registry data from 2014 to 2024, including all hospital deliveries. Each birth was linked to the home ZIP code, maternal demographics, and delivery location. Stillbirth rates per 1,000 births were calculated overall and by ZIP code. Univariate and multivariable logistic regression were used to identify independent predictors. Stillbirths were also mapped by ZIP code to visualize geographic disparities.

Results:
Among 116,125 deliveries, 808 were stillbirths (6.96 per 1,000). In the multivariable analysis shown in Table 1, advanced maternal age (OR: 1.49, p-value: < 0.001), NHPI ethnicity (OR: 1.40, 2.09, p-value: 0.004, < 0.001 respectively), and interisland delivery (OR: 4.38, p-value: < 0.001) were significantly associated with stillbirth. The heat map in Figure 1 revealed clusters of high stillbirth rates in rural ZIP codes on Hawai‘i Island, including 96725, 96737, and 96783. These areas shared characteristics such as higher NHPI populations, lower population density, limited OB care access, and longer travel times to delivery hospitals.

Conclusion:
Stillbirth in Hawai‘i is strongly influenced by both maternal and geographic factors. Disparities are most pronounced in rural communities with reduced healthcare infrastructure and high NHPI populations. In response, we are launching a pilot remote non-stress testing (NST) program in these high risk areas to expand access to antenatal surveillance to reduce the risk of stillbirth across the state.