Abstract
Objective
The study’s objectives were to examine rates of severe maternal morbidity (SMM) over
a 10-year period and assess racial/ethnic disparities in SMM among insured women in
a large, integrated health care system in Southern California.
Methods
We included Kaiser Permanente Southern California (KPSC) health plan members who gave
birth at ≥20 weeks’ gestation in a KPSC-owned hospital during 2008–2017. An SMM case
was defined as presence of one or more indicators of an SMM event during a birth hospitalization,
identified using maternal electronic health records. Crude SMM rates/10,000 births
were calculated by year and maternal race/ethnicity. Modified Poisson regression models
were used to assess the association between race/ethnicity and SMM adjusted for other
maternal demographics, pregnancy characteristics, and preexisting conditions.
Results
We identified 5,915 SMM cases among 335,310 births. Crude SMM rates increased from
94.7 per 10,000 in 2008 to 192.6 in 2015 and 249.5 in 2017. Non-Hispanic Black (adjusted
risk ratio [aRR] 1.52; 95% confidence interval [CI] 1.37–1.69), Asian/Pacific Islander
(aRR 1.29, 95% CI 1.18–1.41), and Hispanic (aRR 1.18, 95% CI 1.10–1.27) women had
greater likelihood of SMM than non-Hispanic White women. After further adjusting for
preexisting health conditions, differences in SMM by race/ethnicity remained.
Conclusions
SMM rates increased during 2008–2017 and women of racial and ethnic minority groups,
particularly non-Hispanic Black women, were more likely to experience an SMM event
than non-Hispanic White women. Multilevel approaches to understanding structural and
social factors that may be associated with racial and ethnic disparities in SMM are
needed to develop and test effective interventions to reduce SMM.
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Biography
Lisa P. Oakley, PhD, MPH, is an Epidemiologist at the Centers for Disease Control and Prevention. This work was conducted while she was serving as a CDC Epidemic Intelligence Service Officer in the Department of Research & Evaluation, Kaiser Permanente Southern California.
Biography
Xia Li, MS, is a Biostatistician in the Department of Research & Evaluation, Kaiser Permanente Southern California.
Biography
Sarah Y. Tartof, PhD, is an Infectious Disease Epidemiologist and Research Scientist in the Department of Research & Evaluation, Kaiser Permanente Southern California.
Biography
Madeline Wilkes-Grundy, MD, is a Physician in the Department of Family Medicine at Kaiser Permanente West Los Angeles Medical Center and Faculty at Kaiser Permanente Bernard J. Tyson School of Medicine.
Biography
Michael J. Fassett, MD, is a Physician and Director of Maternal-Fetal Medicine at Kaiser Permanente West Los Angeles Medical Center and Faculty at Kaiser Permanente Bernard J. Tyson School of Medicine.
Biography
Jean M. Lawrence, ScD, MPH, MSSA, is the Senior Advisor for Diabetes Epidemiology and Program Director for Gestational Diabetes at the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). She also participates in other maternal and women's health activities at NIDDK and NIH.
Article info
Publication history
Published online: February 03, 2023
Accepted:
January 10,
2023
Received in revised form:
December 22,
2022
Received:
February 24,
2022
Publication stage
In Press Corrected ProofFootnotes
Current affiliation of L.P.O.: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Disease, Centers for Disease Control and Prevention.
Current affiliation of J.L.: Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
Funding Statement: This study was supported by Kaiser Permanente Southern California is the funder for the Kaiser Permanente Community Benefit funds. Dr. Jean Lawrence was funded in part through NIH (1R01ES030353-01A1).
The findings and conclusion in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health, George Washington University.
