Hospital Factors Associated with Racial Dispariities in Severe Obstetric Morbidity

The burden posed by maternal mortality and severe morbidity during pregnancy and childbirth in the developed world has long been overlooked and prevention has been neglected despite its vital importance as a component of care quality. While rates of severe maternal morbidity in the United States have clearly increased in the past two decades black women remain at highest risk and maternal outcomes for black women represent a significant health disparity. Research on how hospital-level factors may affect these disparities have demonstrated several concerning findings. Evidence suggests that delivering at black-serving hospitals is associated with increased risk for morbidity; while assessment of obstetric quality measures at black-serving hospitals suggests that that care quality may be poorer hospital factors associated with disparities have not been identified. Utilizing population based data we propose to evaluate a set of factors that may be highly important to racial disparities in severe obstetric morbidity but have yet to be studied. Specifically we will utilize the Nationwide Inpatient Sample (NIS) to identify patients hospitalized for delivery and determine whether they did or did not suffer severe morbidity. We will link the NIS to the American Hospital Association Survey Database and evaluate a diverse set of hospital factors ranging from the degree to which critical care and medical specialty consultative services are available to hospital staffing volume and resources to whether the hospital has services designed to provide access and outreach to vulnerable populations. Currently little is known about how these factors may relate to disparities in maternal morbidity. We will evaluate these associations both in the general population individual racial and ethnic groups and via stratified analyses of hospitals serving primarily non-Hispanic white non-Hispanic black and Hispanic patients. If specific hospital factors are associated with decreased risk for severe morbidity amongst black women these data will provide a rationale for further investigating and improving health disparities in obstetrical care. This proposal addresses an important unmet need for underserved and at-risk young women and mothers in the U.S. Additionally these data may be immediately leveraged to help women make more informed choices on where to receive obstetric care. Ultimately the goal of these studies is to improve the outcomes of obstetric care in the United States.

Friedman A. Clinical implications of maternal disparities administrative data research. Clin Perinatol (47)4. 759-767 DOI:10.1016/j.clp.2020.08.008 December 2020 Clin Perinatol