Racial disparities based on delivery hospital quality reported

Racial disparities based on delivery hospital quality reported | Image Credit: © JenkoAtaman - © JenkoAtaman - stock.adobe.com.

Reports of racial disparities

Black and American Indian individuals deliver at lower-quality hospitals compared to White women, according to a recent study published in JAMA Network Open.¹

Approximately 700 and 60,000 birthing individuals in the United States are impacted by maternal mortality and severe maternal morbidity (SMM), respectively, highlighting a maternal health crisis. These factors also disproportionately impact Black and American Indian women, influenced by drivers such as racism, stress, and a potential decrease in health care quality.²

“Despite extensive research, there is limited understanding of how these racial and ethnic disparities extend to obstetric care, particularly regarding the quality of care at the delivery hospital vs the nearest obstetric hospital based on the birthing individual’s residence,” wrote investigators.¹

Study objectives and methodology

The study was conducted to evaluate disparities in care among birthing individuals in the United States. Inequality was defined as a concentration of individuals from certain racial or ethnic groups in lower-quality hospitals, with relevant groups including Asian, Black, Hispanic, and American Indian individuals.

Both the hospital where the delivery occurred and the closest hospital to a patient’s residential zip code were reported to compare available services to actual delivery choices. Maternal hospital records from California, Oregon, Michigan, South Carolina, and Pennsylvania were obtained for 22- to 44-weeks’ gestation.

Centers for Disease Control and Prevention International Classification of Diseases, Ninth Revision (ICD-9) or ICD-10 codes were used to determine nontransfusion SMM, as transfusion SMM data was not available. This encompassed 16 maternal conditions and 4 procedures.

Covariates included maternal age, parity, prenatal care adequacy, delivery mode, sickle cell disease, gestational age, hospital level of obstetric care and volume, and comorbidities. Maternal hospital discharge data was used to determine the actual delivery hospital, while the travel time to the actual and nearest delivery hospital was calculated using the maternal residential zip code.

Demographics and health conditions

There were 6,418,635 birthing individuals from 549 hospitals included in the final analysis, 0.4% of whom were American Indian, 7.2% Asian, 12.6% Black, 25.6% Hispanic, and 51.1% White. Compared to White and Asian patients, Black, American Indian, and Hispanic patients were more often younger and had government insurance.

Diabetes was most common in American Indian patients and gestational diabetes in Asian patients. The highest median SMM comorbidity score was reported among Black patients, and this population alongside American Indian individuals reported the highest rates of inadequate prenatal care utilization.

Hospital quality disparities among racial groups

Inequality was reported as Lorenz curves by actual delivery hospitals and nearest hospitals. For actual delivery hospitals, indices of -0.02 and -0.04 were reported for Asian and Hispanic patients, respectively, indicating no statistically significant difference in quality compared to White patients.

Lower-quality hospitals were reported among American Indian and Black patients vs White patients, with indices of 0.07 and 0.15, respectively. When evaluating the closest-hospital, inequality indices of 0.01 and -0.02 were reported for Asian and Hispanic individuals, respectively, vs 0.08 and 0.11 for American Indian and Black individuals, respectively.

These curves indicated American Indian and Black patients resided closer to lower-quality hospitals than White patients. However, Black patients would have had a lower inequality index had they delivered at the nearest hospital vs the actual delivery hospital.

Other racial and ethnic groups would have delivered at a lower quality hospital if they delivered at the nearest vs actual hospital. Differences did not occur based on insurance type, except for Black individuals with private insurance residing closer to lower quality hospitals vs those with government insurance.

Conclusion

These results indicated delivery at lower-quality hospitals among American Indian and Black patients vs their White counterparts. Additionally, the data indicated delivery at the nearest hospital would have reduced these disparities.

“Addressing these disparities may require targeted interventions to improve access to high-quality hospitals for minoritized racial and ethnic groups and to address systemic issues that contribute to these disparities,” wrote investigators.

References

1. Boghossian NS, Greenberg LT, Buzas JS, et al. Racial and ethnic inequalities in actual vs nearest delivery hospitals. JAMA Netw Open. 2025;8(3):e251404. doi:10.1001/jamanetworkopen.2025.1404
2. 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):143-52. doi: 10.1016/j.ajog.2016.05.007