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Published on: January 12, 2018
Adverse Maternal Outcome Disparities in a Clinically Low-risk Cohort
Gabriella Mayne1, Natalie Taylor Simon2, Kevin Flores3
1University of Colorado Denver, Department of Health and Behavioral Sciences, United States, Denver.
Objective:
Maternal health in the United States is characterized by persistent racial and ethnic disparities, even among clinically low-risk patients. Health systems often report outcomes in aggregate, a practice that can obscure inequities. We examined adverse maternal outcomes (AMO) among clinically low-risk patients stratified by race/ethnicity and assessed whether area-level social vulnerability differed across geographic patterns of AMO.
Study Design:
We conducted a secondary analysis of 7,691 patients who received intrapartum care from certified nurse-midwives or obstetricians at a tertiary academic hospital between 2013 and 2018. We evaluated severe maternal morbidity (SMM), adapted from CDC criteria, and AMO which included SMM plus postpartum hemorrhage, intra-amniotic infection, obstetric anal sphincter injury, and unplanned cesarean delivery. We stratified outcomes by mutually exclusive, census-derived racial/ethnic categories based on patient self-report. We used chi-squared, Student's t-tests, and one-way ANOVA for comparisons, and logistic regression to assess AMO by racial/ethnic category. We used the Mann-Whitney U test to compare area-level social vulnerability indicators between zip codes with the highest and lowest AMO prevalence, and Geographic Information Systems (GIS) to map the zip code distribution.
Results:
AMO, but not SMM, differed by racial/ethnic category. Patients identifying as non-Hispanic Asian had the highest AMO (38%) and more than twice the odds compared with non-Hispanic White patients (aOR: 2.02; 95% CI: 1.63-2.51; p < 0.001). Zip code-level social vulnerability indicators did not differ by AMO prevalence.
Conclusion:
Racial and ethnic disparities in AMO persisted in a clinically low-risk cohort, underscoring the importance of disaggregated reporting to identify inequities that may be masked in aggregate analyses.
Key Points:
· Racial disparities exist even among low-risk patients.. · AMO, but not SMM, varied by race/ethnicity.. · Non-Hispanic Asian patients had the highest AMO rates.. · Zip code social vulnerability did not differ by AMO prevalence.. · Disaggregated reporting clarifies disparities..
