Gillispie-Bell V, Bane S, Martin J, Kan PY, Mujahid MS, Carmichael SL
Abstract
Objectives: Race-ethnicity and place-based variables such as rurality, ZIP code-level poverty, and county maternity care desert status have been associated with severe maternal morbidity and maternal mortality rates in the US. We examined these associations in Louisiana, which has one of the highest maternal mortality rates in the US. Study design: This was a birth cohort study. Methods: We used state-wide inpatient birth hospitalization discharge data in Louisiana between 2016 and 2021. Mixed-effects logistic regression models with individuals nested within ZIP codes were used to estimate adjusted odds ratios (aOR) for non-transfusion severe maternal morbidity (nt-SMM, defined using the CDC index) according to race-ethnicity and place-based variables (overall and stratified by race-ethnicity). Results: Among 326,597 birth hospitalizations, 2486 (0.77 %) involved nt-SMM. Non-Hispanic Black and Hispanic individuals had increased risk of nt-SMM compared to Non-Hispanic White individuals, after adjustment for sociodemographic factors, a comorbidity index, and place-placed variables (aORs 1.36, 95 %CI 1.23-1.51 and 1.39, 95 %CI 1.21-1.59, respectively). Residence in a maternity care desert county or rural ZIP code did not increase risk; however, residence in a ZIP code in the highest quartile of poverty was associated with increased risk (aOR 1.26, 95 %CI 1.04-1.51). When stratified by race and ethnicity, an increased risk remained for NonHispanic Black and Hispanic individuals residing in the highest-poverty ZIP codes (aORs 1.33, 95 % CI 1.00-1.78 and 1.32, 95 % CI 1.05-1.65, respectively), and a potential increased risk associated with living in a maternity care desert emerged for Black individuals (aOR 1.33, 95 % CI 1.00-1.76), but confidence intervals included 1.00. Conclusions: In Louisiana, to reduce the rate of nt-SMM, social factors must be addressed, especially for nonHispanic Black individuals living in areas with the highest levels of poverty and in maternity care deserts, as they had the highest risks in this population.
