Identification of racial/ethnic disparities associated with severe maternal morbidity using the Arkansas All-Payer...

To evaluate the effect of maternal characteristics on the odds of severe maternal morbidity (SMM) through 42 days postpartum.

We conducted a retrospective observational study of 77 172 births using birth certificate and insurance claims data from the Arkansas All Payers Claims Database, years 2013-2017, to identify racial disparities associated with SMM for births between April 1, 2014, and November 19, 2017.

Multiple logistic regression was used to examine the effect of sociodemographic factors and clinical comorbidities on the odds of SMM among non-Hispanic white ("white"), non-Hispanic Black ("Black"), and Hispanic women.

The rate of SMM was 227.41 per 10 000 births, with Black women (330 per 10 000 births; 95% CI: 296.16-366.38), having a significantly higher rates than white women (197; 95% CI: 171.72-225.84) and Hispanic women (180; 95% CI: 155.86-207.54). After adjusting for maternal demographics, birth-related clinical variables, and comorbidities, SMM remained higher among Black women (aOR 1.37; 95% CI 1.11-1.70) relative to white women.

Comorbidities, socioeconomic factors, and other factors did not fully explain the Black-white disparities in SMM. Persistent disparities in the rates of SMM throughout 42 days postpartum among Black women relative to white women points to the need for higher quality, more equitable care for women of color in the fist months postpartum.