A. Ranjit1, S. Selvarajah1, C. K. Zogg1, E. B. Schneider1, A. H. Haider1 1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research, Department Of Surgery,Baltimore, MD, USA
Introduction: Racial disparities in obstetrics exist in the US, but underlying factors for these are unknown. In countries with low maternal mortality, study of Severe Acute Maternal Morbidity (SAMM) is an effective method of evaluating obstetric care. Use of SAMM, defined as “acute organ dysfunction, which if not treated appropriately, could result in death” allows us to further explore known obstetrics disparities. This study aimed to determine if there are racial disparities in SAMM outcomes using the Nationwide Inpatient Sample (NIS).
Methods: Using 2007-2011 NIS, white, black or Hispanic women of reproductive age (15-49 years) who had normal delivery [ICD-9 diagnosis code V270, 650] were identified. World Health Organization (WHO) proposed criteria was used to identify SAMM. Patient age, insurance status, income, hospital location/type and complications during pregnancy (such as pregnancy induced hypertension (PIH), gestational diabetes (GDM), obesity, renal disease, heart disease) were compared across racial groups. Logistic regression controlling for patient and hospital factors examined race-based differences in the occurrence of SAMM. Complications were examined as follows: 1) any complication qualifying as SAMM, 2) organ specific SAMM or, 3) systemic SAMM.
Results: Among 3,362,976 women identified for analysis, 1,737,861 (51.6%) were white, 462,434(13.75%) black and 792,612(23.57%) Hispanic. White patients were more likely to be older than black and Hispanic patients (mean age 28.1 vs. 25.89 and 26.67 years, respectively, p<0.001). Black patients were more likely to have PIH, obesity and previous cesarean section while Hispanic patients were more likely to have had GDM. A total of 46,489(1.38%) had at least one SAMM; 21,427(0.64%) women had at least one systemic SAMM; and 25,062(0.75%) women had at least one organ-specific SAMM. Black patients were more likely to have any SAMM complication compared to whites, but after adjusting for patient and hospital factors, the difference diminished (table). In contrast, Hispanic patients consistently displayed lower odds of developing any SAMM complications when compared to whites in both univariable and multivariable analysis. When stratified by type of SAMM complication, black patients had greater odds of organ specific SAMM, while Hispanic patients had lower odds of systemic SAMM compared with white patients.
Conclusion: Our findings suggest that race is associated with the odds of developing SAMM during childbirth. It is possible that unexplored pre and perinatal conditions, represented unequally across race groups, may partially explain our findings. Further research is warranted to best understand the relationships between race and maternal health in pregnancy.
