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Am J Perinatol 2019; 36(08): 835-848
DOI: 10.1055/s-0038-1675207
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Virginia Tangel
1   Center for Perioperative Outcomes, Department of Anesthesiology, Weill Cornell Medicine, New York, New York
,
Robert S. White
2   Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
,
Anna S. Nachamie
1   Center for Perioperative Outcomes, Department of Anesthesiology, Weill Cornell Medicine, New York, New York
,
Jeremy S. Pick
2   Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
› Author Affiliations
Further Information

Publication History

06 June 2018

13 September 2018

Publication Date:
05 November 2018 (online)

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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
 

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