Elizabeth A Howell1, Natalia N Egorova, Teresa Janevic, Michael Brodman, Amy Balbierz, Jennifer Zeitlin, Paul L Hebert. 1. Departments of Population Health Science & Policy and Obstetrics, Gynecology, and Reproductive Science and the Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Biostatistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France; and the University of Washington School of Public Health, Seattle, Washington.
Abstract
OBJECTIVE: To examine within-hospital racial and ethnic disparities in severe maternal morbidity rates and determine whether they are associated with differences in types of medical insurance. METHODS: We conducted a population-based, cross-sectional study using linked 2010-2014 New York City discharge and birth certificate data sets (N=591,455 deliveries) to examine within-hospital black-white, Latina-white, and Medicaid-commercially insured differences in severe maternal morbidity. We used logistic regression to produce risk-adjusted rates of severe maternal morbidity for patients with commercial and Medicaid insurance and for black, Latina, and white patients within each hospital. We compared these within-hospital adjusted rates using paired t-tests and conditional logit models. RESULTS: Severe maternal morbidity was higher among black and Latina women than white women (4.2% and 2.9% vs 1.5%, respectively, P<.001) and among women insured by Medicaid than those commercially insured (2.8% vs 2.0%, P<.001). Women insured by Medicaid compared with those with commercial insurance had similar risk for severe maternal morbidity within the same hospital (P=.54). In contrast, black women compared with white women had significantly higher risk for severe maternal morbidity within the same hospital (P<.001), as did Latina women (P<.001). Conditional logit analyses confirmed these findings, with black and Latina women compared with white women having higher risk for severe maternal morbidity (adjusted odds ratio [aOR] 1.52; 95% CI 1.46-1.62 and aOR 1.44; 95% CI 1.36-1.53, respectively) and women insured by Medicaid compared with those commercially insured having similar risk. CONCLUSION: Within hospitals in New York City, black and Latina women are at higher risk of severe maternal morbidity than white women; this is not associated with differences in types of insurance.
OBJECTIVE: To examine within-hospital racial and ethnic disparities in severe maternal morbidity rates and determine whether they are associated with differences in types of medical insurance. METHODS: We conducted a population-based, cross-sectional study using linked 2010-2014 New York City discharge and birth certificate data sets (N=591,455 deliveries) to examine within-hospital black-white, Latina-white, and Medicaid-commercially insured differences in severe maternal morbidity. We used logistic regression to produce risk-adjusted rates of severe maternal morbidity for patients with commercial and Medicaid insurance and for black, Latina, and white patients within each hospital. We compared these within-hospital adjusted rates using paired t-tests and conditional logit models. RESULTS: Severe maternal morbidity was higher among black and Latina women than white women (4.2% and 2.9% vs 1.5%, respectively, P<.001) and among women insured by Medicaid than those commercially insured (2.8% vs 2.0%, P<.001). Women insured by Medicaid compared with those with commercial insurance had similar risk for severe maternal morbidity within the same hospital (P=.54). In contrast, black women compared with white women had significantly higher risk for severe maternal morbidity within the same hospital (P<.001), as did Latina women (P<.001). Conditional logit analyses confirmed these findings, with black and Latina women compared with white women having higher risk for severe maternal morbidity (adjusted odds ratio [aOR] 1.52; 95% CI 1.46-1.62 and aOR 1.44; 95% CI 1.36-1.53, respectively) and women insured by Medicaid compared with those commercially insured having similar risk. CONCLUSION: Within hospitals in New York City, black and Latina women are at higher risk of severe maternal morbidity than white women; this is not associated with differences in types of insurance.
Authors: Shagufta Yasmeen; Patrick S Romano; Michael E Schembri; Janet M Keyzer; William M Gilbert Journal: Am J Obstet Gynecol Date: 2006-04 Impact factor: 8.661
Authors: J Margo Brooks-Carthon; Ann Kutney-Lee; Douglas M Sloane; Jeannie P Cimiotti; Linda H Aiken Journal: J Nurs Scholarsh Date: 2011-07-25 Impact factor: 3.176
Authors: Paul L Hebert; Elizabeth A Howell; Edwin S Wong; Susan E Hernandez; Seppo T Rinne; Christine A Sulc; Emily L Neely; Chuan-Fen Liu Journal: Health Serv Res Date: 2016-06-03 Impact factor: 3.402
Authors: Paul Logan Weygandt; Lia I Losonczy; Eric B Schneider; Mehreen T Kisat; Lauren K Licatino; Edward E Cornwell; Elliot R Haut; David T Efron; Adil H Haider Journal: J Surg Res Date: 2012-07-22 Impact factor: 2.192
Authors: Kimberly M Schaefer; Anna M Modest; Michele R Hacker; Lucy Chie; Yamicia Connor; Toni Golen; Rose L Molina Journal: Matern Child Health J Date: 2021-04-27
Authors: Shalmali Bane; Suzan L Carmichael; Jonathan M Snowden; Can Liu; Audrey Lyndon; Elizabeth Wall-Wieler Journal: Ann Epidemiol Date: 2021-08-19 Impact factor: 3.797
Authors: Riccardo Lemini; Iktej S Jabbal; Krystof Stanek; Shalmali R Borkar; Aaron C Spaulding; Scott R Kelley; Dorin T Colibaseanu Journal: BMC Surg Date: 2021-03-25 Impact factor: 2.102