Community Level Factors and Racial Inequities in Delivery Hospitalizations Involving Severe Maternal Morbidity in the United States, 2016-2019

Abstract

Objective To evaluate the risk of severe maternal morbidity (SMM) at delivery associated with community factors (community income and location of residence) by race/ethnicity. Methods We used the Healthcare Cost and Utilization Project 2016–2019 National Inpatient Sample. International Classification of Diseases, Tenth Revision, Clinical Modification codes identified delivery hospitalizations with SMM. Using survey weights, delivery hospitalizations with SMM were predicted as a function of community factors using logistic regression models, with subsequent stratification by race/ethnicity. Results In rural areas, Native Americans had the largest disparity in delivery hospitalizations involving SMM (AOR: 2.09; 95% CI: 1.71–2.55). In large metropolitan areas, Blacks had the largest disparity in delivery hospitalizations involving SMM (AOR: 1.91; 95% CI: 1.84–1.99). For community income, there was an increasing trend in disparity for Blacks among delivery hospitalizations involving SMM from (AOR: 1.67; 95% CI:1.59–1.74) for the lowest quartile of community income to (AOR: 2.03; 95% CI: 1.90–2.17) for the quartile with the highest community income. Conclusions We found that community factors contribute to the racial and ethnic differences in SMM in the United States. These factors, outside of individual factors assessed in previous studies, provide a better understanding of some of the structural and systemic factors that may contribute to SMM.