Racial, age, and community level maternal disparities at an academic health center

Candace N Holloway, G. Gillespie, B. Clayton
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Abstract

Objective: Racial and ethnic minority women experience more maternal deaths and comorbid illnesses than non-Hispanic White women. The purpose of the current study was to identify if maternal health disparities exist at an urban academic health center.Methods: A retrospective chart review was conducted of a systematic random sample of women who delivered a child in 2017. The study setting was an urban academic health center Level III neonatal intensive care unit serving a high percentage of racial minority patients. Data were analyzed using relative risks (RR) with 95% confidence intervals.Results: Findings reflect an increased risk for maternal complications for minority and older aged women. Specifically, risk was higher for Black (RR: 3.818) and Hispanic/Latino (RR: 2.354) women compared to non-Hispanic White women for cesarean section and for older women (age 35 years or older) compared to younger women for cesarean section (RR: 2.671) and preeclampsia (RR: 3.422). While White, non-Hispanic women did not incur pre-eclampsia or hemorrhage with intervention, minority women did experience these maternal complications.Conclusions: Maternal health inequities exist within this sample of women giving birth at an academic health center. Healthcare providers can conduct self-assessments to determine their implicit biases that may be contributing to health disparities.
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学术保健中心的种族、年龄和社区层面的产妇差异
目的:种族和少数民族妇女比非西班牙裔白人妇女经历更多的孕产妇死亡和合并症。本研究的目的是确定在城市学术保健中心是否存在孕产妇保健差异。方法:对2017年分娩妇女进行系统随机抽样的回顾性图表分析。研究设置在一个城市学术卫生中心三级新生儿重症监护室,为高比例的少数种族患者提供服务。数据分析采用相对危险度(RR),置信区间为95%。结果:研究结果反映了少数民族和老年妇女发生产妇并发症的风险增加。具体而言,与非西班牙裔白人女性相比,黑人(RR: 3.818)和西班牙裔/拉丁裔(RR: 2.354)女性剖宫产的风险更高;与年轻女性相比,年龄较大的女性(35岁或以上)剖宫产(RR: 2.671)和先兆子痫(RR: 3.422)。虽然白人和非西班牙裔妇女在干预中没有发生先兆子痫或出血,但少数民族妇女确实经历了这些产妇并发症。结论:在这个在学术卫生中心分娩的妇女样本中存在孕产妇保健不平等。医疗保健提供者可以进行自我评估,以确定他们可能导致健康差异的内隐偏见。
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