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Patient- and Hospital- Level Disparities in Severe Maternal Morbidity: a Retrospective Multistate Analysis, 2015-2020
Elizabeth Khusid1, Briana Lui1, Virginia E Tangel2
1Weill Cornell Medical College, Weill Cornell Medicine, NY, New York, USA.
Journal of Racial and Ethnic Health Disparities
|August 23, 2023
Summary
Severe maternal morbidity (SMM) increased disproportionately for racial/ethnic minorities. Delivering in Black-serving units independently and interactively increased SMM odds, highlighting persistent racial disparities in maternal healthcare.
Area of Science:
- Public Health
- Maternal Health
- Health Disparities
Background:
- Severe maternal morbidity (SMM) rates rose 9% in the US (2018-2020), disproportionately impacting minority populations.
- Existing research suggests hospital-level factors contribute to SMM, even after accounting for patient characteristics.
- Women delivering in high Black-serving units showed increased SMM odds, indicating potential systemic issues.
Purpose of the Study:
- To analyze multi-level racial/ethnic disparities in SMM by examining patient- and hospital-level factors.
- To investigate the impact of patient and hospital factors on SMM, including blood transfusions.
- To understand the interactive effects of race, ethnicity, and delivery unit characteristics on maternal morbidity.
Main Methods:
- Retrospective cohort study using multistate data from 2015 to 2020.
- Analysis of 3,497,233 deliveries, focusing on SMM, SMM excluding blood transfusion, and blood transfusions alone.
- Multivariable logistic regression models to assess patient- and hospital-level factors influencing SMM odds.
Main Results:
- Black race, Hispanic ethnicity, and delivery at Black-serving units independently increased odds of SMM.
- Interactive effects between race/ethnicity and delivery unit type further elevated SMM risk.
- Blood transfusions alone were associated with 1.30% of deliveries, while SMM occurred in 1.63%.
Conclusions:
- Structural and individual-level racial/ethnic disparities in maternal outcomes persist.
- Delivering in Black-serving units exacerbates SMM risk for minority women.
- Multi-level public policies are crucial to address and mitigate racial/ethnic disparities in maternal healthcare.
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