Maternal Health Trends and Disparities in Hawaiʻi: Visualizing Pregnancy Risk Assessment Monitoring System Data Through an Interactive Shiny Web Application

Significant racial and socioeconomic disparities persist in maternal health outcomes in Hawaiʻi, particularly among Native Hawaiian, Pacific Islander, and other historically marginalized populations.While the Pregnancy Risk Assessment Monitoring System (PRAMS) offers robust maternal health surveillance data, few tools exist to dynamically explore this information at the state level.The objective of this study was to develop and deploy an interactive data visualization tool using Hawaiʻi PRAMS data to examine maternal health patterns stratified by race, education level, and socioeconomic status.The authors developed an R Shiny web application using publicly available PRAMS data from 2000 to 2022 (Phases 4-8).The application includes a trend-display tab using survey-weighted estimates and a logistic regression tab examining adjusted associations between demographic factors and maternal outcomes.Both features account for the complex survey design.A total of 32 710 responses were analyzed.The application displayed differences across racial, educational, and socioeconomic groups, while cross-phase comparisons were treated as exploratory because questionnaire items and coding changed over time.Multivariable logistic regression identified associations between demographic characteristics and selected maternal health outcomes.This tool offers an accessible platform for exploring maternal health data in Hawaiʻi and supports hypothesis generation and data-informed discussion among researchers, public health professionals, and policymakers. Abbreviations and AcronymsARF = PRAMS Automated Research File NHPI = Native Hawaiian and Pacific Islander OR = odds ratio PRAMS = Pregnancy Risk Assessment Monitoring System PSU = primary sampling unit SES = socioeconomic status