Racial and ethnic disparities in severe maternal morbidity in two health systems in North Carolina

To evaluate the association between race/ethnicity and the incidence of severe maternal morbidity (SMM) at two large health care systems in North Carolina. This is retrospective study of births at two large health care systems in North Carolina from January 1, 2016, to December 31, 2020. Each system includes a self-designated “Level IV” maternity care facility. Electronic medical records were used to extract demographic and pregnancy-related data. The exposure of interest was race or ethnicity, as documented in the record. To ensure an adequate sample size and occurrence of the outcome, this analysis was limited to non-Hispanic Black, Hispanic, and non-Hispanic White pregnant people. The primary outcome of interest was non-transfusion SMM at the time of birth hospitalization as defined by the Centers for Disease Control and Prevention, and the secondary outcome was all SMM. The Obstetric Comorbidity Index (OB-CMI) was as defined by Leonard (2020). Chi-square tests and multivariable logistic regressions were performed to evaluate differences among the racial and ethnic groups, and in the incidence of SMM. The study included 73,596 births of non-Hispanic Black, non-Hispanic White, and Hispanic birthing people. There were significant differences among groups by age, payer, gestational age at delivery and route of delivery, and OB-CMI score (Table 1). In unadjusted analyses, non-Hispanic Black people were significantly more likely to experience non-transfusion SMM (Figure A). After adjusting for payer, delivery route, and OB-CMI, both non-Hispanic Black and Hispanic birthing people had a higher odds of non-transfusion SMM and all SMM (Figure B) than birthing white people. In adjusted analyses, the odds of non-transfusion SMM were highest among Hispanic people. Non-Hispanic Black and Hispanic birthing people had significantly higher odds of non-transfusion SMM at two North Carolina health systems. These data continue to affirm the importance of non-clinical factors such as structural racism and socioeconomic factors on obstetric outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)