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Racial and Ethnic Inequalities in Actual vs Nearest Delivery Hospitals
Nansi S Boghossian1, Lucy T Greenberg2, Jeffrey S Buzas3
1Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
JAMA Network Open
|March 21, 2025
Summary
Racial disparities in obstetric care persist, with American Indian and Black individuals often receiving lower-quality care. This inequality could be reduced if Black individuals delivered at their nearest hospital, highlighting systemic issues in maternal healthcare access.
Area of Science:
- Obstetrics and Gynecology
- Health Services Research
- Health Equity
Background:
- Minoritized racial and ethnic groups, including American Indian and Black individuals, experience disparities in healthcare quality compared to White individuals.
- Understanding these disparities in obstetric care, specifically comparing actual delivery hospitals versus nearest options based on residence, is limited.
Purpose of the Study:
- To examine disparities in obstetric care quality based on the actual delivery hospital versus the nearest hospital to the birthing individual's residential zip code.
- To quantify racial and ethnic inequalities in maternal healthcare delivery locations.
Main Methods:
- A population-based retrospective cohort study analyzed data from 5 US states between 2008 and 2020.
- Included individuals giving birth to a fetal death or live birth between 22 to 44 weeks gestational age.
- Calculated an obstetric inequality index using Gini coefficients and standardized morbidity ratios to compare hospital quality across racial and ethnic groups.
Main Results:
- American Indian and Black individuals delivered at lower-quality hospitals compared to White individuals.
- No significant difference in hospital quality was observed for Asian and Hispanic individuals versus White individuals.
- Black individuals resided closer to lower-quality hospitals; delivering at the nearest hospital would have reduced inequality for this group.
Conclusions:
- Significant disparities exist in the quality of hospitals where American Indian and Black individuals deliver compared to White individuals.
- The gap in care quality for Black individuals could be narrowed if they utilized their nearest hospital for delivery.
- Findings underscore the need to address systemic factors contributing to unequal access to high-quality obstetric care.
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