Key result
Non-Hispanic Black women face ~65% higher severe maternal morbidity and mortality vs White women across communities.
Why the study?
Severe maternal morbidity and mortality are increasing in the US with healthcare disparities among Non-Hispanic Black women, but data on disparities by race/ethnicity related to community type are sparse.
Does residing in rural communities increase racial/ethnic disparities in severe maternal morbidity and mortality among women admitted for delivery?
Cross-Sectional (n=204,140)
Does residing in rural communities increase racial/ethnic disparities in severe maternal morbidity and mortality among women admitted for delivery?
Odds Ratio: 1.65 (95% CI 1.46–1.88)
p-value: p=<0.001
Racial and ethnic disparities in severe maternal morbidity and mortality exist but are not significantly modified by residing in rural versus urban communities.
Highlights need for equity-focused maternal protocols; leaves open mechanisms and interventions beyond community type.
Background: Severe maternal morbidity and mortality are increasing in the United States with continued healthcare disparities among Non-Hispanic Black women. However, there is sparse data on the disparities of severe maternal morbidity and mortality by race/ethnicity as it relates to community type. Objective: To determine whether residing in rural communities increases the racial/ethnic disparities in severe maternal morbidity and mortality. Design: This study is a cross-sectional analysis of women admitted for delivery from 2015 to 2020. A total of 204,140 adults who self-identified as women, were admitted for delivery, who resided in Maryland, and were between the ages 15 and 54 were included in our analysis. Community type was defined as either rural or urban. Methods: A multivariable logistic regression, which included an interaction term between race/ethnicity and community type, was used to assess the effect of community type on the relationship between race/ethnicity and severe maternal morbidity and mortality. Data were obtained from the Maryland Health Service Cost Review Commission database. The primary outcome was a composite, binary variable of severe maternal morbidity and mortality. Exposures of interest were residence in either rural or urban counties in Maryland and race/ethnicity. Results: Our study found that after adjusting for confounders, odds of severe maternal morbidity and mortality were 65% higher in Non-Hispanic Black women (odds ratio 1.65, 95% confidence interval: 1.46–1.88, p < 0.001) and 54% higher in Non-Hispanic Asian women (odds ratio 1.54, 95% confidence interval: 1.24–1.90, p < 0.001) compared to Non-Hispanic White women. The interaction term used to determine whether community type modified the relationship between race/ethnicity and severe maternal morbidity and mortality was not statistically significant for any race/ethnicity (Non-Hispanic Black women, p = 0.60; Non-Hispanic Asian women, p = 0.91; Hispanic women, p = 0.15; Other/Unknown race/ethnicity, p = 0.54). Conclusion: Although our study confirmed the known disparities in maternal outcomes by race/ethnicity, we found that residing in rural communities did not increase racial/ethnic disparities.
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Cudjoe et al. (2023) conducted a cross-sectional in Severe maternal morbidity and mortality (n=204,140). Non-Hispanic Black race/ethnicity vs. Non-Hispanic White women was evaluated on Composite, binary variable of severe maternal morbidity and mortality (OR 1.65, 95% CI 1.46-1.88, p=<0.001). Non-Hispanic Black women had significantly higher odds of severe maternal morbidity and mortality compared to Non-Hispanic White women (OR 1.65; 95% CI 1.46-1.88; p<0.001), unaffected by community type.
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