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Race and Ethnicity, Medical Insurance, and Within-Hospital Severe Maternal Morbidity Disparities

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.
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https://www.hal.inserm.fr/inserm-03134875
Contributor : Marianne Philibert <>
Submitted on : Monday, February 8, 2021 - 3:24:54 PM
Last modification on : Wednesday, June 2, 2021 - 4:26:10 PM
Long-term archiving on: : Sunday, May 9, 2021 - 7:37:57 PM

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Elizabeth Howell, Natalia Egorova, Teresa Janevic, Michael Brodman, Amy Balbierz, et al.. Race and Ethnicity, Medical Insurance, and Within-Hospital Severe Maternal Morbidity Disparities. Clinical and experimental obstetrics & gynecology, Irog Canada Inc., 2020, 135 (2), pp.285-293. ⟨10.1097/AOG.0000000000003667⟩. ⟨inserm-03134875⟩

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