title: Severe Maternal Morbidity Among Hispanic Women in New York City: Investigation of Health Disparities.
abstract: To investigate differences in severe maternal morbidity between Hispanic mothers and three major Hispanic subgroups compared with non-Hispanic white mothers and the extent to which differences in delivery hospitals may contribute to excess morbidity among Hispanic mothers.
  
  
  
  We conducted a population-based cross-sectional study using linked 2011-2013 New York City discharge and birth certificate data sets (n=353,773). Rates of severe maternal morbidity were calculated using a published algorithm based on diagnosis and procedure codes. Mixed-effects logistic regression with a random hospital-specific intercept was used to generate risk-standardized severe maternal morbidity rates for each hospital taking into consideration patient sociodemographic characteristics and comorbidities. Differences in the distribution of Hispanic and non-Hispanic white deliveries were assessed among these hospitals in relation to their risk-adjusted morbidity. Sensitivity analyses were conducted after excluding isolated blood transfusion from the morbidity composite.
  
  
  
  Severe maternal morbidity occurred in 4,541 deliveries and was higher among Hispanic than non-Hispanic white women (2.7% compared with 1.5%, P<.001); this rate was 2.9% among those who were Puerto Rican, 2.7% among those who were foreign-born Dominican, and 3.3% among those who were foreign-born Mexican. After adjustment for patient characteristics, the risk remained elevated for Hispanic women (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.22-1.66) and for all three subgroups compared with non-Hispanic white women (P<.001). Risk for Hispanic women was attenuated in sensitivity analyses (OR 1.17, 95% CI 1.02-1.33). Risk-standardized morbidity across hospitals varied sixfold. We estimate that Hispanic-non-Hispanic white differences in delivery location may contribute up to 37% of the ethnic disparity in severe maternal morbidity rates in New York City hospitals.
  
  
  
  Hispanic compared with non-Hispanic white mothers are more likely to deliver at hospitals with higher risk-adjusted severe maternal morbidity rates and these differences in site of delivery may contribute to excess morbidity among Hispanic mothers. Our results suggest improving quality at the lowest performing hospitals could benefit both non-Hispanic white and Hispanic women and reduce ethnic disparities in severe maternal morbidity rates.
authors.affiliation: Departments of Population Health Science & Policy and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France; and the University of Washington School of Public Health, Seattle, Washington.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Howell
authors.forename: Natalia N
authors.initials: NN
authors.lastname: Egorova
authors.forename: Teresa
authors.initials: T
authors.lastname: Janevic
authors.forename: Amy
authors.initials: A
authors.lastname: Balbierz
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zeitlin
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hebert
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004293:Dominican Republic / Q000208:ethnology; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008800:Mexico / Q000208:ethnology; D009017:Morbidity; D009519:New York City / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000208:ethnology; D011647:Puerto Rico / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data*