Racial and Ethnic Disparities in Maternal Outcomes and the Disadvantage of Peripartum Black Women: A Multistate Analysis, 2007-2014

Am J Perinatol. 2019 Jul;36(8):835-848. doi: 10.1055/s-0038-1675207. Epub 2018 Nov 5.

Abstract

Objective: Racial and ethnic disparities in obstetric care and delivery outcomes have shown that black women experience high rates of pregnancy-related mortality and morbidity, along with high rates of cesarean delivery, compared with other racial and ethnic groups. We aimed to quantify these disparities and test the effects of race/ethnicity in stratified statistical models by insurance payer and socioeconomic status, adjusting for comorbidities specific to an obstetric population.

Study design: We analyzed maternal outcomes in a sample of 6,872,588 delivery records from California, Florida, Kentucky, Maryland, and New York from 2007 to 2014 from the State Inpatient Databases, Healthcare Cost and Utilization Project. We compared present-on-admission characteristics of parturients by race/ethnicity, and estimated logistic regression and generalized linear models to assess outcomes of in-hospital mortality, cesarean delivery, and length of stay.

Results: Compared with white women, black women were more likely to die in-hospital (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.47-2.45) and have a longer average length of stay (incidence rate ratio: 1.10, 95% CI: 1.09-1.10). Black women also were more likely to have a cesarean delivery (OR: 1.12, 95% CI 1.12-1.13) than white women. These results largely held in stratified analyses.

Conclusion: In most insurance payers and socioeconomic strata, race/ethnicity alone is a factor that predicts parturient outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • African Americans*
  • Cesarean Section / statistics & numerical data*
  • Comorbidity
  • Delivery, Obstetric / adverse effects
  • European Continental Ancestry Group
  • Female
  • Health Status Disparities*
  • Healthcare Disparities / ethnology
  • Hispanic Americans
  • Hospital Mortality / ethnology*
  • Humans
  • Length of Stay
  • Linear Models
  • Logistic Models
  • Maternal Mortality / ethnology*
  • Retrospective Studies
  • United States / epidemiology