New evidence suggests that hospitals may be a contributing factor to the racial and socioeconomic disparities found in pregnancy complications.
An analysis published Monday in Health Affairs found women living in ZIP codes that had the highest concentration of poor black residents had a life-threatening condition or life-saving procedure during childbirth 4 out of every 100 deliveries from 2012 to 2014 compared with 1.7 cases per 100 deliveries among women in neighborhoods with the lowest concentration of poor black residents.
Study co-author Teresa Janevic, assistant professor of obstetrics, gynecology and reproductive science, and population health science and policy at Mount Sinai Health's Icahn School of Medicine in New York, said about half of the difference in severe maternal morbidity cases was due to poor health conditions among black women living in low-income neighborhoods. Black women in poor neighborhoods were found to have higher rates of chronic conditions such as obesity, high blood pressure and diabetes, all of which increases the risk for pregnancy complications.
But about one-third of the difference in maternal morbidity could be attributed to care quality issues at the delivery hospital. Previous studies estimated more than half of maternal deaths and a third of severe morbidity cases that occur in the U.S. each year are preventable. Experts have said the figures point to a need for hospitals to improve quality-of-care problems such as misdiagnosis and a failure to detect warning signs of a possible complication.
While healthcare providers in poor neighborhoods had higher rates of severe complications, Janevic said the findings seems to indicate race may be a large risk factor for maternal morbidity and mortality.
A report released in January by the National Center for Health Statistics found there were 658 maternal deaths in 2018, representing a mortality rate of 17.4 deaths per 100,000 live births. While the overall mortality rate has improved, black women die at more than double the rate for white women.
Janevic said the ability of individuals to choose hospitals with higher care quality helps to widen the disparities in outcomes between them and those limited to getting care at their neighborhood provider where the quality of care may be lower.
The study found 32% of women who lived in mostly black neighborhoods delivered in hospitals serving mostly black communities, while 1% of women from mostly white neighborhoods delivered in hospitals located in predominantly black neighborhoods.
By contrast, 55% of women from neighborhoods with the highest concentration of low-income households delivered in hospitals with a similar concentration of low-income households compared with 21% of women from the high-income neighborhoods who delivered at hospitals located in a predominantly low-income area.
White women living in predominantly poor black neighborhoods didn't have the same rates of severe morbidity during pregnancy, which Janevic said suggested that they were more likely going to hospitals in other neighborhoods to receive care.
The findings speak to the notion that the neighborhood where someone lives could be a social determinant of health that is helping drive the socioeconomic inequalities found among racially segregated communities.
Janevic said the findings show past policies and actions responsible for the racial segregation of neighborhoods should be taken into account when examining and comparing care quality.
"Not only do you risk-adjust in your models for hospital quality, you have to understand that this is a matter of structural racism of driving and funneling populations into certain poor-quality hospitals," Janevic said.