Racial and ethnic disparities in maternal and infant health

Dr. Howell’s presentation focused on the longstanding disparities in maternal morbidity and very preterm birth morbidity and mortality.

Her presentation had an unfortunate recent example of maternal morbidity, with the passing of Dr. Chaniece Wallace, a Black pediatrician who died on Oct. 24 after dealing with preeclampsia and delivering her first child on Oct. 20.

This article is based on information presented at the American College of Obstetrics and Gynecologists’ (ACOG) 2020 Virtual Conference. For more information, click here.

On Friday, Oct. 30, Elizabeth A. Howell, MD, MPP, led a presentation on the intertwined racial and ethnic disparities in maternal and infant health that exist for women and babies of color.

According to Howell’s latest research, Black mothers are more likely to deliver at higher risk-standardized severe maternal morbidity hospitals than are white mothers.¹

“We have a lot of science around quality improvement. We can apply that science and use it in conjunction with other important strategies to improve the way we care for patients and addressing the issues of bias,” said Dr. Howell, presenter and Chair of the Department of Obstetrics & Gynecology at the Perelman School of Medicine at the University of Pennsylvania.

There is a wide range of factors that contribute to racial and ethnic disparities in maternal and neonatal care, including those of the patient, community/neighborhood, provider, and system. High-performing hospitals, according to Howell, have a stronger focus on standards and standardized care; stronger nurse/physician communication; more awareness of the presence of racism in the hospital; and sharing of performance data with nurses and frontline staff.

To further investigate the racial and ethnic disparities in maternal and neonatal care, Howell first focused on the differences in severe mortality rates in New York City hospitals in which Black and white women deliver. For this analysis, data were collected from a linked 2011-2013 New York City discharge and birth certificate dataset (n=353,773).¹

Howell’s research team applied a mixed-effects logistics regression with a random hospital-specific intercept to generate risk-standardized severe maternal morbidity rates for each hospital (n=40).1

The research showed that Black women experienced the highest rates of severe maternal morbidity at 4.2%, compared with Latinx at 2.7% and White at 1.5%. Her team concluded that differences in hospital of delivery may account for up to 48% of the Black-White disparity and 37% of the Latinx-White disparity.¹

The next steps for Howell’s research will include hospital qualitative interviews (high- and low-performing), focus groups to explore patient barriers to receipt of high-quality health care, and dissemination efforts to promote an increase in uptake of best practices.

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Reference

1. Howell EA, Egorova NN, Balbierz A, Zeitlin J, Hebert PL. Site of delivery contribution to black-white severe maternal morbidity disparity. Am J Obstet Gynecol. 2016;215(2):143-152. doi:10.1016/j.ajog.2016.05.007