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Related Experiment Video

Updated: Sep 18, 2025

A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
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Decomposing Racial Disparities in Severe Maternal Morbidity Within Insurance Groups.

E Kathleen Adams1, Sara Markowitz2, Michael R Kramer3

  • 1Department of Health Policy and Management (HPM), Rollins School of Public Health (RSPH), Emory University, Atlanta, Georgia, USA.

Health Economics
|June 21, 2025
PubMed
Summary
This summary is machine-generated.

Racial disparities in severe maternal morbidity (SMM) are influenced by hospital care and residential factors. Within-hospital processes significantly explain the Black-White SMM gap, especially for Medicaid patients.

Keywords:
health insurancematernal morbidityracial disparities

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Area of Science:

  • Maternal Health
  • Health Disparities
  • Health Services Research

Background:

  • Severe maternal morbidity (SMM) rates are linked to maternal, hospital, and residential factors.
  • The contribution of these factors to racial disparities in SMM among different insurance groups remains unclear.
  • Understanding these disparities is crucial for improving maternal health outcomes.

Purpose of the Study:

  • To investigate the contribution of maternal, hospital, and residential factors to racial disparities in SMM.
  • To compare the Black-White SMM gap between Medicaid and privately insured groups.
  • To quantify the explained portion of the SMM gap using Oaxaca-Blinder decomposition.

Main Methods:

  • Utilized linked Georgia vital records and hospital discharge data from 2016-2020.
  • Identified SMM during delivery and up to 42 days postpartum.
  • Employed Oaxaca-Blinder decomposition with linear probability models, including hospital fixed-effects.

Main Results:

  • The Black-White SMM gap was lower for Medicaid (1.15/100) than privately insured (1.40/100) individuals.
  • Hospital fixed-effects explained a larger portion of the gap for Medicaid (42.9%) compared to privately insured (29.4%).
  • Residential factors reduced the explained gap for Medicaid (-19.6%) but had minimal impact for the privately insured (0%).

Conclusions:

  • Differences in within-hospital processes by race significantly contribute to the Black-White SMM gap.
  • Residential factors, particularly provider access, may help reduce this gap among Medicaid-insured individuals.
  • Targeted interventions addressing in-hospital care and socioeconomic factors are needed to reduce SMM disparities.