Black and Latina mothers in New York City are more likely than white women to experience severe delivery complications even when they have the similar types of health insurance and give birth at the same hospital, a new study suggests.
Researchers examined data on 591,455 deliveries at 40 hospitals in New York City from 2010 to 2014. They calculated the risk of serious complications such as heart attacks, cardiac arrest, kidney failure, respiratory distress, heart failure, hysterectomy or the need for blood transfusions, breathing tubes or ventilators.
Within any given hospital, black women were 52% more likely to experience these complications than white mothers, and Latina women had a 44% greater risk, the study found. The risk of complications was similar whether women had private health insurance or were insured by Medicaid, the U.S. health program for the poor.
“Our findings are consistent with other research demonstrating that socioeconomic status does not explain racial/ethnic disparities in severe maternal morbidity,” said lead study author Dr. Elizabeth Howell, director of the Blavatnik Family Women’s Health Research Institute at the Icahn School of Medicine at Mount Sinai in New York City.
“Other factors such as implicit bias, communication skills, structural racism and different care patterns may contribute to racial and ethnic disparities within hospitals,” Howell said by email.
Overall, 4.2% of black women and 2.9% of Latina women experienced severe complications, compared with 1.5% of white women.
Severe maternal morbidity was slightly more common overall among low-income women insured by Medicaid, at 2.8%, than among women with private health insurance, at 2.0%, the study team notes in Obstetrics & Gynecology.
Researchers expected insurance differences to help explain racial disparities because pregnant women with Medicaid are often seen by residents - doctors in training - who are supervised by different physicians than the physicians who tend to deliver women with private insurance. But insurance type did not explain these disparities, Howell said.
One limitation of the analysis is that it relied on data from billing records, which don’t include detailed clinical information on individual patients.
More research is needed to look at how prenatal care or social and community factors might contribute to racial and ethnic disparities in maternal health outcomes within hospitals, the study team notes.
Even so, the results build on previous research documenting racial disparities in maternity care, said Carol Rowland Hogue of the Rollins School of Public Health at Emory University in Atlanta.
“Institutional racism manifests in inter-generational segregation, reduced life prospects and neighborhood deficits that even the best medical care cannot eliminate,” Hogue, who wasn’t involved in the study, said by email.
Racism can result in women avoiding or postponing prenatal care that might identify weight gain issues, pregnancy-related hypertension, undiagnosed diabetes and other precursors of severe maternal complications, Hogue said.
“Within-hospital interpersonal racism has been documented to affect even the wealthiest and best-educated women of color through their providers’ failure to recognize serious symptoms and move quickly to avert disaster,” Hogue added.
SOURCE: bit.ly/2uPWyBh Obstetrics & Gynecology, online January 9, 2020.
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