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Using spatial Bayesian models to estimate associations between structural racial discrimination and disparities in
Jasmin A Darville1, Katherine Campbell2, Kaitlyn K Stanhope2
1Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Social Science & Medicine (1982)
|March 13, 2025
Summary
Structural racism in Georgia exacerbates severe maternal morbidity (SMM) disparities for Black birthing people. Counties with higher resource deprivation and racial polarization showed greater SMM racial differences.
Area of Science:
- Public Health
- Health Disparities
- Sociomedical Sciences
Background:
- The United States faces a maternal health crisis, particularly in Georgia, where Black birthing individuals experience disproportionately high rates of severe maternal morbidity (SMM).
- In Georgia, Black individuals account for 35% of all births, with SMM rates significantly exceeding national averages.
Purpose of the Study:
- To investigate the relationship between structural racial discrimination (SRD) and severe maternal morbidity (SMM) among Black versus white birthing people in Georgia.
- To analyze how county-level SRD, defined by four domains, influences racial disparities in SMM.
Main Methods:
- Utilized Georgia linked live birth/fetal death certificate and hospital discharge data from 2013 to 2021.
- Defined county-level structural racial discrimination (SRD) across four domains.
- Estimated county-specific SMM rates using Bayesian conditional autoregressive Poisson models.
- Compared SMM rate differences between Black and white birthing individuals across SRD strata.
Main Results:
- The study included 709,335 deliveries. SMM prevalence was higher in Black (3.2%) versus white (1.7%) birthing individuals, a mean difference of 13.1 per 1000 deliveries.
- Larger Black-white racial disparities in SMM were observed in counties with high resource deprivation compared to affluent counties.
- Greater racial disparities in SMM were found in counties with polarized Black and low-income populations compared to homogeneous ones.
Conclusions:
- Structural racism is intricately linked to severe maternal morbidity (SMM) outcomes in Georgia.
- Significant racial disparities in SMM persist, particularly influenced by socioeconomic factors and racial composition at the county level.
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