Race and Ethnicity, Medical Insurance, and Within-Hospital Severe Maternal Morbidity Disparities

Abstract

Objective: To examine within-hospital racial and ethnic disparities in severe maternal morbidity rates and determine whether they are associated with differences in types of medical insurance.

Methods: We conducted a population-based, cross-sectional study using linked 2010-2014 New York City discharge and birth certificate data sets (N=591,455 deliveries) to examine within-hospital black-white, Latina-white, and Medicaid-commercially insured differences in severe maternal morbidity. We used logistic regression to produce risk-adjusted rates of severe maternal morbidity for patients with commercial and Medicaid insurance and for black, Latina, and white patients within each hospital. We compared these within-hospital adjusted rates using paired t-tests and conditional logit models.

Results: Severe maternal morbidity was higher among black and Latina women than white women (4.2% and 2.9% vs 1.5%, respectively, P<.001) and among women insured by Medicaid than those commercially insured (2.8% vs 2.0%, P<.001). Women insured by Medicaid compared with those with commercial insurance had similar risk for severe maternal morbidity within the same hospital (P=.54). In contrast, black women compared with white women had significantly higher risk for severe maternal morbidity within the same hospital (P<.001), as did Latina women (P<.001). Conditional logit analyses confirmed these findings, with black and Latina women compared with white women having higher risk for severe maternal morbidity (adjusted odds ratio [aOR] 1.52; 95% CI 1.46-1.62 and aOR 1.44; 95% CI 1.36-1.53, respectively) and women insured by Medicaid compared with those commercially insured having similar risk.

Conclusion: Within hospitals in New York City, black and Latina women are at higher risk of severe maternal morbidity than white women; this is not associated with differences in types of insurance.

Figure 1.

Maternal insurance status of black, Latina, and white deliveries in New York City hospitals, 2010–2014.

Figure 2.

Within hospital comparison of risk-adjusted severe maternal morbidity for Medicaid versus commercially-insured deliveries (P=.54) (A); black versus white deliveries (P<.001) (B); and Latina versus white deliveries (P<.01) (C). P values are calculated using paired t-test.

Figure 3:

Within hospital comparison of risk-adjusted severe maternal morbidity for hospitals with percentage of Medicaid deliveries between 20% and 80%: Medicaid versus commercially insured deliveries (P=.65) (A); black versus white deliveries (P<.001) (B); and Latina versus white deliveries (P<.001) (C). P values are calculated using paired t-test.

Figure 4.

Association of risk-adjusted severe maternal morbidity with percentage of Medicaid deliveries in New York City hospitals.