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.
Keywords
racial/ethnic disparities - in-hospital maternal mortality - cesarean delivery - administrative
database - outcomes research - maternal length of stay
