Intersectional inequities in maternal mortality: Examining the compounded risks for black birthing individuals with physical disabilities.

IF 3.7 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES Disability and Health Journal Pub Date : 2024-12-03 DOI:10.1016/j.dhjo.2024.101765

Ilhom Akobirshoev, Sarah Jerome, Jonathan M Snowden, Jaime Slaughter-Acey, Anne Valentine, Willi Horner-Johnson, Monika Mitra

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Abstract

Background: People who are Black and have physical disabilities likely face a dual burden of risk for maternal mortality due to enduring systemic oppression rooted in racism and ableism.

Objective: To investigate maternal mortality risks among Black birthing individuals with physical disabilities in the United States and assess the potential compounding effect when these marginalized identities intersect.

Methods: We conducted a historical cohort study using the 2004-2021 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. The study included 8,263,997 delivery hospitalizations. We used modified Poisson regression to estimate unadjusted and adjusted relative risks (RR) of maternal mortality by race and physical disability status. We calculated the Relative Excess Risk due to Interaction (RERI) and Attributable Proportion (AP) to assess additive interaction between Black race and physical disability status.

Results: After adjusting for covariates, compared to their White birthing individuals, their Black peers experienced about 2.5 times (RR = 1.48,95%CI:2.08-2.96) the risk of maternal mortality. Compared to birthing individuals without physical disabilities, those with physical disabilities experienced nearly 11 times the (RR = 10.72,95%CI:8.15-14.10) risk of maternal mortality. Our adjusted additive interaction analysis revealed a significant super-additive effect (RERI = 11.3; AP = 0.47); suggesting that the combined effect of having both marginalized identities was greater than the sum of the individual effects of each identity.

Conclusions: Our findings provide evidence for substantial inequities in maternal mortality by Black race and physical disability status, with evidence of a compounding effect when these marginalized identities intersect. These results underscore the urgent need for intersectional approaches in maternal health interventions and policies.

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产妇死亡率的交叉不平等：检查身体残疾的黑人生育个体的复合风险。

背景：由于种族主义和残疾歧视的系统性压迫，身体残疾的黑人可能面临孕产妇死亡风险的双重负担。目的：调查美国黑人残疾产妇的孕产妇死亡风险，并评估这些边缘化身份交叉时的潜在复合效应。方法：我们使用2004-2021年医疗成本和利用项目全国住院患者样本进行了历史队列研究。该研究包括8,263,997例分娩住院病例。我们使用修正泊松回归来估计种族和身体残疾状况下未调整和调整的产妇死亡率相对风险（RR）。我们计算了相互作用的相对超额风险（Relative Excess Risk due to Interaction， RERI）和归因比例（Attributable ratio， AP），以评估黑人种族和身体残疾状况之间的附加相互作用。结果：调整协变量后，与白人分娩个体相比，黑人分娩个体的孕产妇死亡率风险约为2.5倍（RR = 1.48,95%CI:2.08-2.96）。与没有身体残疾的分娩个体相比，身体残疾的产妇死亡率风险几乎是其11倍（RR = 10.72,95%CI:8.15-14.10）。经校正的加性相互作用分析显示了显著的超加性效应(RERI = 11.3；ap = 0.47)；这表明拥有两种边缘化身份的综合影响大于每一种身份的个人影响的总和。结论：我们的研究结果为黑人种族和身体残疾状况在孕产妇死亡率方面的重大不平等提供了证据，并证明当这些边缘化身份交叉时，会产生复合效应。这些结果强调迫切需要在孕产妇保健干预措施和政策方面采取交叉方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Disability and Health Journal HEALTH CARE SCIENCES & SERVICES-PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

CiteScore

7.50

自引率

6.70%

发文量

134

审稿时长

34 days

期刊介绍： Disability and Health Journal is a scientific, scholarly, and multidisciplinary journal for reporting original contributions that advance knowledge in disability and health. Topics may be related to global health, quality of life, and specific health conditions as they relate to disability. Such contributions include: • Reports of empirical research on the characteristics of persons with disabilities, environment, health outcomes, and determinants of health • Reports of empirical research on the Systematic or other evidence-based reviews and tightly conceived theoretical interpretations of research literature • Reports of empirical research on the Evaluative research on new interventions, technologies, and programs • Reports of empirical research on the Reports on issues or policies affecting the health and/or quality of life for persons with disabilities, using a scientific base.