Kathleen Adams

Emory University, United States

Title: What Factors Explain the Racial GAP in Severe Maternal Morbidity (SMM) in the Southeastern US?

---

Biography

Adams is an Economist who has spent her career applying economic tools to large, secondary data bases with a focus on low-income and vulnerable populations and on Medicaid policies and issues.  She holds degrees in Mathematics and Economics and has previously worked at the Education Commission of the States, the American Medical Association (AMA) and SysteMetrics. While at Emory, she completed work with the Division of Reproductive Health (DRH) at the Centers for Disease Control and Prevention (CDC) on insurance transitions during pregnancy, the costs of smoking during pregnancy and the effects of cigarette taxes on maternal smoking.  Currently, she leads the evaluation of the effects of the Medicaid family planning waiver, P4HB® in Georgia and is M-PI on an NIH funded study called ‘Minding the Gap’ (MTG) using linked vital records and hospital discharge abstract data to analyze racial disparities in severe maternal morbidity (SMM) in Georgia.

Abstract

The maternal mortality rate in the United States (US) far exceeds that of other industrialized countries, with Black mortality rates three times that of white women. Severe maternal morbidity (SMM) reflects unintended outcomes of labor and delivery resulting in serious short- or long-term health consequences, and is regarded as a “near-miss” outcome proximate to maternal mortality. SMM rates are also increasing and systematically higher for Black women.  We used linked hospital discharge, birth and fetal death records data from Georgia, a large and racially diverse state in the Southeastern US, to examine the Black-white SMM gap.  We identified occurrences of 21 SMM indicator conditions during delivery or subsequent hospitalizations through 42 days postpartum for 413,124 deliveries to non-Hispanic white (229,357, 56%) or Black (183,767, 44%) women 2016-2020.  The rate of SMM/100 discharges among non-Hispanic Black (3.15) was 1.8 times that of white (1.73) individuals. We estimated race-specific logistic models and used the Oaxaca-Blinder decomposition technique to derive an “explained portion” of the gap attributed to: 1) sociodemographic factors; 2) medical conditions; 3) obstetrical factors; 4) access to care; 5) hospital factors and 6) residential factors.  Models including indicators reflecting within-hospital processes explained a larger portion of the gap and, notably, hospital-specific effects were the largest explanatory contributor to the Black-white SMM gap at 15.1%, followed by access (14.9%) and sociodemographic factors (14.4%). Residential factors, indicative of provider access, were largely protective for Black individuals (-7.5%) in Georgia. As almost half of deliveries in the US are publicly insured, we re-estimated models by insurance. Here too, hospital-specific effects increase the percentage of the racial gap explained, especially among the publicly insured.  Differences in within-hospital processes by race contribute a large portion of the discriminatory SMM gap, while greater provider access reduces the gap, especially among the publicly insured in Georgia.