Racial Disparities in Severe Maternal Morbidity: The Role of Maternal Comorbidities

The U.S. maternal health crisis disproportionately affects Black women, who face nearly twice the risk of severe maternal morbidity (SMM) compared with White women. Using 2016-2022 Texas hospital discharge data and a validated obstetric comorbidity score, the analysis first documents that the prevalence of SMM increased by 18% between 2016 and 2022, whereas maternal comorbidity burden increased by 42% over the same period. To better assess the role of comorbidities, the comorbidity score is disaggregated into underlying health and pregnancy-specific conditions. Oaxaca-Blinder decompositions indicate that the former accounts for the largest share-49 to 53%-of the Black-White SMM gap, while the latter accounts for an additional third of the disparity. After accounting for these factors, a residual Black-White SMM gap of 17%-20% persists across and within hospitals, including among women treated by the same physician. Overall, the findings underscore the critical need to improve women's health well before childbirth hospitalization and throughout the reproductive life course, while also strengthening prenatal care to prevent and effectively manage conditions that arise during pregnancy.