Neighborhood deprivation and racial disparities in severe maternal morbidity before and during the COVID-19 pandemic

Abstract

Purpose: To examine whether racial and ethnic disparities in severe maternal morbidity (SMM) increased across all neighborhoods or mainly in resource-deprived neighborhoods before and during the COVID-19 pandemic.

Methods: This study used Michigan's statewide linked databases from birth records and Medicaid claims between 01/01/2017 and 10/31/2021 (N = 214,406). Neighborhood deprivation was measured with Area Deprivation Index and categorized into tertiles. Multilevel logistic regressions with an interrupted time series approach were used to compare racial and ethnic disparities in SMM pre-pandemic (January 2017-February 2020) and during the pandemic (March 2020-October 2021) in low, medium, and high deprivation neighborhoods.

Results: The Black-White disparity in the most deprived neighborhoods widened during the pandemic (adjusted risk ratio, aRR [95 % CI]: 1.72 [1.54, 1.92]; excess cases [95 % CI]: 201.7 [159.0, 244.5]) compared to pre-pandemic (aRR [95 % CI]: 1.23 [1.12, 1.35]; excess cases [95 % CI]: 75.4 [41.2, 109.5], p < .001), but persisted (not widened) in the least and medium deprived neighborhoods.

Conclusions: Widening racial and ethnic disparities in SMM during the pandemic were only observed in the most deprived neighborhoods, rather than being universally prevalent across neighborhood contexts. Community-engaged solutions are needed to improve neighborhood conditions and reduce maternal health inequities during times of crisis.

Keywords: Health disparity; Maternal health; Neighborhood disadvantage; Severe maternal morbidity; Social determinants of health.