A new report from the Agency for Healthcare Research and Quality (AHRQ) shows that over a 10-year period in the United States, rates of severe maternal morbidity increased. Age, race, and income, the authors found, all played a role in disparities in specific related trends.
The data, spanning 2006 through 2015, are reviewed in an AHRQ Healthcare Cost and Utilization Project (HCUP) Statistical Brief. The analysis file used was derived from the HCUP State Inpatient Databases (SID) and weighted to provide national estimates calculated with the same methodology as the Nationwide Inpatient Sample (NIS). SID encompasses more than 95% of all US community hospital discharges; NIS is nationally representative of all community hospitals.
For the analysis, severe maternal morbidity was defined using 21 indicators developed by the Centers for Disease Control and Prevention, including conditions and procedures performed during a woman’s hospital stay. Between 2006 and 2015, the rate of severe maternal morbidity increased 45%--from 101.3 to 146.6 per 10,000 delivery hospitalizations. Blood transfusion, disseminated intravascular coagulation and hysterectomy were the most common indicators of that morbidity.
Looking at factors related to severe maternal morbidity, the authors found trends associated with age, race, and income. Rates were highest in women aged ≥ 40 and lowest in those aged 20 to 29. Black women had rates of severe maternal morbidity 112% to 115% higher than for white women (164 vs 176 in 2006 and 241 vs 114 in 2006 and 2015, respectively).
Over time, deaths among women of all races and ethnicities declined, but in 2015, in-hospital mortality was three times higher for black women than for white women. Women who were on Medicaid or uninsured also had higher rates of severe maternal morbidity on delivery than those who had private insurance (176.5 and 175.0 per 10,000 delivery hospitalizations for Medicaid and uninsured versus private insurance, respectively).
Blood transfusion was the most common indicator of severe maternal morbidity and performed in approximately 80% of cases reflected in the data file. Deliveries complicated by severe maternal morbidity also were more likely to occur at hospitals that typically serve vulnerable populations—safety-net (43.6% vs 35.1%) and minorities (53.4% vs 44.3%). Geographically, those deliveries tended to be in the northeast and south rather than in the midwest or west.
Overall, black and Hispanic women and women of other races and ethnicities were overrepresented among deliveries involving severe maternal morbidity, as compared with white women.