The role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality: a retrospective case note review
<p><strong>Background</strong></p> Reasons for ethnic disparities in maternal death in the UK are unclear and may be explained by differences in social risk factors and engagement with maternity services. <p><strong>Methods</strong></p> In this retros...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2022
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| _version_ | 1797109594643759104 |
|---|---|
| author | Cosstick, E Nirmal, R Cross-Sudworth, F Knight, M Kenyon, S |
| author_facet | Cosstick, E Nirmal, R Cross-Sudworth, F Knight, M Kenyon, S |
| author_sort | Cosstick, E |
| collection | OXFORD |
| description | <p><strong>Background</strong></p>
Reasons for ethnic disparities in maternal death in the UK are unclear and may be explained by differences in social risk factors and engagement with maternity services.
<p><strong>Methods</strong></p>
In this retrospective systematic case note review, we used anonymised medical records from MBRRACE-UK for all Other than White, and White European/Other women plus a random sample of White British/Irish women who died in pregnancy or up to 1 year afterwards from 01/01/2015 to 12/31/2017. We used a standardised data extraction tool developed from a scoping review to explore social risk factors and engagement with maternity services.
<p><strong>Findings</strong></p>
Of 489 women identified, 219 were eligible for the study and 196 case notes were reviewed, including 103/119 from Other than White groups, 33/37 White European/Other and a random sample of 60/333 White British/Irish. The presence of three or more social risk factors was 11⋅7% (12/103) in Other than White women, 18⋅2% (6/33) for White European/Other women and 36⋅7% (22/60) in White British/Irish women. Across all groups engagement with maternity services was good with 85⋅5% (148/196) receiving the recommended number of antenatal appointments as was completion of antenatal mental health assessment (123/173, 71⋅1%). 15⋅5% (16/103) of Other than White groups had pre-existing co-morbidities and 51⋅1% (47/92) had previous pregnancy problems while women across White ethnic groups had 3⋅2% (3/93) and 33⋅3% (27/81) respectively. Three or more unscheduled healthcare attendances occurred in 60⋅0% (36/60) of White British/Irish, 39⋅4% (13/33) in White European/Other and 35⋅9% (37/103) of Other than White women. Evidence of barriers to following healthcare advice was identified for a fifth of all women. None of the 17 women who required an interpreter received appropriate provision at all key points throughout their maternity care.
<p><strong>Interpretation</strong></p>
Neither increased social risk factors or barriers to engagement with maternity services appear to underlie disparities in maternal mortality. Management of complex social factors and interpreter services need improvement.
<p><strong>Funding</strong></p>
National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands. |
| first_indexed | 2024-03-07T07:43:49Z |
| format | Journal article |
| id | oxford-uuid:5b225cd1-615b-4970-bb1a-70b209a732d0 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:43:49Z |
| publishDate | 2022 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:5b225cd1-615b-4970-bb1a-70b209a732d02023-05-16T16:11:40ZThe role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality: a retrospective case note reviewJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:5b225cd1-615b-4970-bb1a-70b209a732d0EnglishSymplectic ElementsElsevier2022Cosstick, ENirmal, RCross-Sudworth, FKnight, MKenyon, S<p><strong>Background</strong></p> Reasons for ethnic disparities in maternal death in the UK are unclear and may be explained by differences in social risk factors and engagement with maternity services. <p><strong>Methods</strong></p> In this retrospective systematic case note review, we used anonymised medical records from MBRRACE-UK for all Other than White, and White European/Other women plus a random sample of White British/Irish women who died in pregnancy or up to 1 year afterwards from 01/01/2015 to 12/31/2017. We used a standardised data extraction tool developed from a scoping review to explore social risk factors and engagement with maternity services. <p><strong>Findings</strong></p> Of 489 women identified, 219 were eligible for the study and 196 case notes were reviewed, including 103/119 from Other than White groups, 33/37 White European/Other and a random sample of 60/333 White British/Irish. The presence of three or more social risk factors was 11⋅7% (12/103) in Other than White women, 18⋅2% (6/33) for White European/Other women and 36⋅7% (22/60) in White British/Irish women. Across all groups engagement with maternity services was good with 85⋅5% (148/196) receiving the recommended number of antenatal appointments as was completion of antenatal mental health assessment (123/173, 71⋅1%). 15⋅5% (16/103) of Other than White groups had pre-existing co-morbidities and 51⋅1% (47/92) had previous pregnancy problems while women across White ethnic groups had 3⋅2% (3/93) and 33⋅3% (27/81) respectively. Three or more unscheduled healthcare attendances occurred in 60⋅0% (36/60) of White British/Irish, 39⋅4% (13/33) in White European/Other and 35⋅9% (37/103) of Other than White women. Evidence of barriers to following healthcare advice was identified for a fifth of all women. None of the 17 women who required an interpreter received appropriate provision at all key points throughout their maternity care. <p><strong>Interpretation</strong></p> Neither increased social risk factors or barriers to engagement with maternity services appear to underlie disparities in maternal mortality. Management of complex social factors and interpreter services need improvement. <p><strong>Funding</strong></p> National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands. |
| spellingShingle | Cosstick, E Nirmal, R Cross-Sudworth, F Knight, M Kenyon, S The role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality: a retrospective case note review |
| title | The role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality: a retrospective case note review |
| title_full | The role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality: a retrospective case note review |
| title_fullStr | The role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality: a retrospective case note review |
| title_full_unstemmed | The role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality: a retrospective case note review |
| title_short | The role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality: a retrospective case note review |
| title_sort | role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality a retrospective case note review |
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