Obstetrical health care inequities in a universally insured health care systemAJOG Global Reports at a Glance
BACKGROUND: Racial and ethnic disparities in health care exist and are rooted in long-standing systemic inequities. These disparities result in significant excess health care expenditures and are due to complex interactions between patients, health care providers and systems, and social and environm...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-08-01
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| Series: | AJOG Global Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666577823000977 |
| _version_ | 1797740762560987136 |
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| author | Shara Fuller, MD Molly Kuenstler, MD Marie Snipes, PhD Michael Miller, MD Monica A. Lutgendorf, MD |
| author_facet | Shara Fuller, MD Molly Kuenstler, MD Marie Snipes, PhD Michael Miller, MD Monica A. Lutgendorf, MD |
| author_sort | Shara Fuller, MD |
| collection | DOAJ |
| description | BACKGROUND: Racial and ethnic disparities in health care exist and are rooted in long-standing systemic inequities. These disparities result in significant excess health care expenditures and are due to complex interactions between patients, health care providers and systems, and social and environmental factors. In perinatal care, these inequities also exist, with Black patients being 3 to 4 times more likely to die of childbirth compared with White patients. Similar health care inequities may also exist in the Military Health System despite universal health care coverage, stable employment, and social programs that benefit military families. OBJECTIVE: This study aimed to evaluate racial disparities in obstetrical outcomes in the Military Health System. STUDY DESIGN: This is a retrospective cohort study of deliveries from 2019 to 2021 in the Military Health System, which provides obstetrical care for approximately 35,000 annual deliveries. The study was conducted using National Perinatal Information Center data on cesarean delivery, postpartum hemorrhage, and severe maternal morbidity by race and ethnicity from direct-care military hospitals representing tertiary care medical centers and community hospitals in the United States and abroad. Chi-square analyses and binary logistic regression were used to compare groups. RESULTS: The cohort included 68,918 deliveries. Of these, 32,358 (47%) were White, 9594 (13.9%) Black, 3120 (4.5%) Asian Pacific Islander, 456 (0.7%) American Indian/Alaska Native, 19,543 (28.4%) other, 3976 (5.8%) unknown, 7096 (10.3%) Hispanic, 58,009 (84.2%) non-Hispanic, and 4399 (6.4%) other ethnicity. Rates of cesarean delivery were significantly higher for Black (30%; odds ratio, 1.44; 95% confidence interval, 1.37–1.52), Asian Pacific Islander (27%; odds ratio, 1.24; 95% confidence interval, 1.14–1.35), and other (26%; odds ratio, 1.20; 95% confidence interval, 1.15–1.25) compared with White race (23%) (P<.001). Postpartum hemorrhage rates were higher for Black (5.9%; odds ratio, 1.11; 95% confidence interval, 1.00–1.24) and Asian Pacific Islander (7.7%; odds ratio, 1.49; 95% confidence interval, 1.29–1.72) compared with White race (5.3%) (P<.001). Severe maternal morbidity was higher for Black (2.9%; odds ratio, 1.44; 95% confidence interval, 1.24–1.67), Asian Pacific Islander (2.9%; odds ratio, 1.45; 95% confidence interval, 1.15–1.82), and other (2.8%; odds ratio, 1.36; 95% confidence interval, 1.21–1.54) compared with White race (2.1%) (P<.001). For severe maternal morbidity excluding blood transfusions, rates were also significantly higher for Black (1%; odds ratio, 1.68; 95% confidence interval, 1.30–2.17) than for White race (0.6%) (P<.002). Hispanic ethnicity was associated with a lower rate of severe maternal morbidity excluding transfusions (0.5%; odds ratio, 0.68; 95% confidence interval, 0.48–0.98) compared with non-Hispanic ethnicity (0.7%) (P=.04). CONCLUSION: Racial disparities in obstetrical outcomes exist in the Military Health System despite universal health care coverage, with significantly higher rates of cesarean delivery and severe maternal morbidity in Black, Asian Pacific Islander, and other races compared with White race. These findings suggest that these disparities are likely related to other factors or social determinants of health rather than availability of health care and insurance coverage. Further work should include investigation into such social determinants of health to address their causes, including systemic and structural barriers. |
| first_indexed | 2024-03-12T14:17:04Z |
| format | Article |
| id | doaj.art-029d507eff804346bad8cabea3d30eed |
| institution | Directory Open Access Journal |
| issn | 2666-5778 |
| language | English |
| last_indexed | 2024-03-12T14:17:04Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AJOG Global Reports |
| spelling | doaj.art-029d507eff804346bad8cabea3d30eed2023-08-20T04:38:49ZengElsevierAJOG Global Reports2666-57782023-08-0133100256Obstetrical health care inequities in a universally insured health care systemAJOG Global Reports at a GlanceShara Fuller, MD0Molly Kuenstler, MD1Marie Snipes, PhD2Michael Miller, MD3Monica A. Lutgendorf, MD4Department of Gynecologic Surgery and Obstetrics, Naval Medical Center San Diego, San Diego, CA (Drs Fuller and Miller)Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD (Dr Kuenstler and Dr Lutgendorf)Department of Mathematics and Statistics, Kenyon College, Gambier, OH (Dr Snipes)Department of Gynecologic Surgery and Obstetrics, Naval Medical Center San Diego, San Diego, CA (Drs Fuller and Miller)Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD (Dr Kuenstler and Dr Lutgendorf); Corresponding author: Monica A. Lutgendorf, MD.BACKGROUND: Racial and ethnic disparities in health care exist and are rooted in long-standing systemic inequities. These disparities result in significant excess health care expenditures and are due to complex interactions between patients, health care providers and systems, and social and environmental factors. In perinatal care, these inequities also exist, with Black patients being 3 to 4 times more likely to die of childbirth compared with White patients. Similar health care inequities may also exist in the Military Health System despite universal health care coverage, stable employment, and social programs that benefit military families. OBJECTIVE: This study aimed to evaluate racial disparities in obstetrical outcomes in the Military Health System. STUDY DESIGN: This is a retrospective cohort study of deliveries from 2019 to 2021 in the Military Health System, which provides obstetrical care for approximately 35,000 annual deliveries. The study was conducted using National Perinatal Information Center data on cesarean delivery, postpartum hemorrhage, and severe maternal morbidity by race and ethnicity from direct-care military hospitals representing tertiary care medical centers and community hospitals in the United States and abroad. Chi-square analyses and binary logistic regression were used to compare groups. RESULTS: The cohort included 68,918 deliveries. Of these, 32,358 (47%) were White, 9594 (13.9%) Black, 3120 (4.5%) Asian Pacific Islander, 456 (0.7%) American Indian/Alaska Native, 19,543 (28.4%) other, 3976 (5.8%) unknown, 7096 (10.3%) Hispanic, 58,009 (84.2%) non-Hispanic, and 4399 (6.4%) other ethnicity. Rates of cesarean delivery were significantly higher for Black (30%; odds ratio, 1.44; 95% confidence interval, 1.37–1.52), Asian Pacific Islander (27%; odds ratio, 1.24; 95% confidence interval, 1.14–1.35), and other (26%; odds ratio, 1.20; 95% confidence interval, 1.15–1.25) compared with White race (23%) (P<.001). Postpartum hemorrhage rates were higher for Black (5.9%; odds ratio, 1.11; 95% confidence interval, 1.00–1.24) and Asian Pacific Islander (7.7%; odds ratio, 1.49; 95% confidence interval, 1.29–1.72) compared with White race (5.3%) (P<.001). Severe maternal morbidity was higher for Black (2.9%; odds ratio, 1.44; 95% confidence interval, 1.24–1.67), Asian Pacific Islander (2.9%; odds ratio, 1.45; 95% confidence interval, 1.15–1.82), and other (2.8%; odds ratio, 1.36; 95% confidence interval, 1.21–1.54) compared with White race (2.1%) (P<.001). For severe maternal morbidity excluding blood transfusions, rates were also significantly higher for Black (1%; odds ratio, 1.68; 95% confidence interval, 1.30–2.17) than for White race (0.6%) (P<.002). Hispanic ethnicity was associated with a lower rate of severe maternal morbidity excluding transfusions (0.5%; odds ratio, 0.68; 95% confidence interval, 0.48–0.98) compared with non-Hispanic ethnicity (0.7%) (P=.04). CONCLUSION: Racial disparities in obstetrical outcomes exist in the Military Health System despite universal health care coverage, with significantly higher rates of cesarean delivery and severe maternal morbidity in Black, Asian Pacific Islander, and other races compared with White race. These findings suggest that these disparities are likely related to other factors or social determinants of health rather than availability of health care and insurance coverage. Further work should include investigation into such social determinants of health to address their causes, including systemic and structural barriers.http://www.sciencedirect.com/science/article/pii/S2666577823000977obstetrical disparitiesobstetrical inequitiesracial disparitiesracial inequities |
| spellingShingle | Shara Fuller, MD Molly Kuenstler, MD Marie Snipes, PhD Michael Miller, MD Monica A. Lutgendorf, MD Obstetrical health care inequities in a universally insured health care systemAJOG Global Reports at a Glance AJOG Global Reports obstetrical disparities obstetrical inequities racial disparities racial inequities |
| title | Obstetrical health care inequities in a universally insured health care systemAJOG Global Reports at a Glance |
| title_full | Obstetrical health care inequities in a universally insured health care systemAJOG Global Reports at a Glance |
| title_fullStr | Obstetrical health care inequities in a universally insured health care systemAJOG Global Reports at a Glance |
| title_full_unstemmed | Obstetrical health care inequities in a universally insured health care systemAJOG Global Reports at a Glance |
| title_short | Obstetrical health care inequities in a universally insured health care systemAJOG Global Reports at a Glance |
| title_sort | obstetrical health care inequities in a universally insured health care systemajog global reports at a glance |
| topic | obstetrical disparities obstetrical inequities racial disparities racial inequities |
| url | http://www.sciencedirect.com/science/article/pii/S2666577823000977 |
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