Racial and Ethnic Disparities in Delivery In-Hospital Mortality or Maternal End-Organ Injury: A Multistate Analysis,...

Area of Science:

• Public Health
• Health Disparities
• Maternal Health

Background:

• Black maternal mortality rates in the U.S. are 2-4 times higher than White rates.
• Severe maternal morbidity and other adverse outcomes also show racial disparities.
• Limited research has comprehensively examined multilevel social determinants of health impacting obstetrical outcomes.

Purpose of the Study:

• To comprehensively study multilevel social determinants of health.
• To assess confounding and effect modification on obstetrical outcomes by race/ethnicity.
• To analyze disparities in maternal mortality and morbidity.

Main Methods:

• Retrospective multistate analysis of adult inpatient delivery hospitalizations (2007-2020).
• Utilized multilevel multivariable models to test confounder-adjusted associations.
• Performed stratified analyses to test for effect modification by race/ethnicity.

Main Results:

• Black (OR: 1.33) and Hispanic (OR: 1.14) patients had higher odds of in-hospital mortality or maternal end-organ injury compared to White patients.
• These disparities remained significant across most strata for Black and Hispanic patients.
• Black patients had significantly higher odds of in-hospital mortality (OR: 1.49) compared to White patients after adjustment.

Conclusions:

• Black and Hispanic patients experience higher adjusted odds of in-patient mortality and end-organ damage post-birth.
• Race and ethnicity are strong predictors of healthcare inequality, reflecting structural racism and implicit bias.
• Addressing these disparities requires multifaceted efforts at societal, hospital, and patient levels to restructure obstetrical care.