Oral Concurrent Session 2 - Health Equity and Disparities
21 - Services and safety-net burden of Black-serving hospitals and related Severe Maternal Morbidity
Thursday, January 28, 2021
4:45 PM – 5:00 PM EST
Objective: More detailed evaluation of hospital factors related to obstetric outcomes may be important in understanding disparities. We aimed to examine detailed characteristics of Black-serving hospitals and associated risk for severe maternal morbidity (SMM).
Study Design: In this cross-sectional study, we linked the 2010-2011 Nationwide Inpatient Sample and the 2013 American Hospital Association Annual Survey databases. Delivery hospitalizations occurring to women 15-54 years of age were identified. The proportions of non-Hispanic Black (nHB) women within a hospital were categorized into quartiles, and hospital factors such as specialized medical, surgical and safety net services were compared across these quartiles. Log-linear models based on the Poisson distribution, with Black-serving hospital (term previously described) quartile as the primary exposure and SMM as the outcome were performed with unadjusted and adjusted risk ratios (aRR) as measures of effect.
Results: Overall 965,202 deliveries from 430 hospitals met inclusion criteria and were included in the analysis. By quartile, nHB patients accounted for 1.3%, 5.4%, 13.4%, and 33.8% of patients. Many services were less common in the lowest compared to the highest Black-serving hospital quartile including cardiac intensive care (48.9% versus 74.5%), neonatal intensive care (28.9% versus 64.9%), pediatric intensive care in (20.0% versus 45.7%), and HIV/AIDS services (36.3% versus 71.3%) (Table 1). Safety-net services were more common at Black-serving hospitals as was Medicaid payer. Following adjustment, the lowest Black-serving hospital quartile carried the lowest risk for SMM. However, SMM risks were similar across other quartiles: 2nd (aRR 1.23, 95% CI 1.14, 1.34), 3rd (aRR 1.12, 95% 1.02, 1.23), and 4th (aRR 1.05, 95% CI 0.94, 1.18) (Table 2).
Conclusion: Black-serving hospitals were more likely to provide a range of specialized medical and surgical services and to have a higher safety-net burden. Case-mix associated with specialized services and Medicaid burden may account for some of the maternal risk associated with Black-serving hospitals.