National Hospital Care Survey Demonstration Projects: Severe Maternal Morbidity in Inpatient and Emergency Departments

Alford, Josephine M.; Williams, Sonja; Oriaku, Michelle N.; White, Donielle; Jackson, Geoffrey G.

doi:10.15620/cdc:109829

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…Consequently, comparisons of averages and percentages between groups were not evaluated using statistical testing, and reported results should not be generalized to all patients who had delivery hospitalizations at U.S. hospitals. Additionally, previous studies have highlighted the limitations of using the Centers for Disease Control and Prevention's SMM definition to identify delivery hospitalizations involving SMM; these limitations are detailed elsewhere (9).…”

Section: Discussionmentioning

confidence: 99%

“…This data linkage provided a unique resource for extensive research on a variety of patient health outcomes, including understanding the role of housing assistance as a social determinant of health. NHCS data alone have been used previously as a source for studying maternal health outcomes (9). The linkage of NHCS data to HUD administrative data is an opportunity to study demographic characteristics and maternal health outcomes by housing assistance status.…”

Section: Department Of Housing and Urban Development (Hud)mentioning

confidence: 99%

“…Gestational age-The age in weeks of the pregnancy at the time of delivery. Gestational age was identified using the last two digits of the ICD-10-CM diagnosis code Z3A-for example, the code Z3A.33 corresponds to a gestational age of 33 weeks (9). Gestational age was reported as an average and as a categorical outcome of preterm (gestational age of less than 37 weeks) or term (37 weeks or later) birth.…”

Section: Maternal Health Outcomesmentioning

confidence: 99%

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National Hospital Care Survey Demonstration Projects: Examination of Maternal Health Outcomes by Housing Assistance Status

Alford,

Guluma,

Gidali

et al. 2024

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Section: Discussionmentioning

confidence: 99%

Section: Department Of Housing and Urban Development (Hud)mentioning

confidence: 99%

Section: Maternal Health Outcomesmentioning

confidence: 99%

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National Hospital Care Survey Demonstration Projects: Examination of Maternal Health Outcomes by Housing Assistance Status

Alford,

Guluma,

Gidali

et al. 2024

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“…Advanced maternal age is usually defined as being 35 years or older which is believed to predispose mothers to enormous adverse outcomes during pregnancy and delivery [1]. According to Alford and his colleagues, It is defined as the mother's age of 35 years or over at delivery, associated with an increased risk of Severe Maternal Mortality [2]. Center for Disease Control and Prevention (CDC) data by 2020 demonstrates the continued upward trend in the mean age of pregnancy was 19% and 11% from all pregnancies and first pregnancies among women aged 35 years and older [3].…”

Section: Introductionmentioning

confidence: 99%

Determinants of advanced age pregnancy in Ethiopian; multi-level analysis of Ethiopian demographic health survey 2016

Tesega,

Enyew,

Tesfaye

et al. 2024

PLoS ONE

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Background Advanced maternal-age pregnancy has become a serious public health problem in both developed and developing countries due to adverse birth outcomes for the mother, fetus, or newborn. However, there are limited studies conducted to identify determinants of advanced-age pregnancy in Ethiopia. Therefore, this study aimed to assess individual and community-level determinants of advanced age pregnancy in Ethiopia. Methods This study was based on 2016 Ethiopian Demographic and Health Survey data. Three thousand two hundred ninety-two weighted samples of pregnant women were included in this analysis. A multilevel logistic regression model was conducted to assess the determinants of advanced-age pregnancy among the study participants in Ethiopia. Results maternal age at first birth (AOR = 4.05, 95% CI: 1.77–9.22), level of maternal education [primary education 2.72 times (AOR = 2.27, 95 CI: 1.55–4.76) and secondary and above education (AOR = 5.65, 95% CI: 1.77–17.70)], having a history of alcohol (AOR = 11.8, 95% CI: 5.71–24.42), parity (AOR = 3.22, 95% CI: 2.69–3.84), number of household member (AOR = 1.22, 95% CI: 1.05–1.41), family planning unmet need for spacing of pregnancy (AOR = 4.79, 95% CI: 2.63–8.74), having sons/daughters elsewhere (AOR = 1.89, 95% CI: 1.22–2.94), had higher community poverty level (AOR = 2.37, 95% CI: 1.16–4.85), those had higher community unmet need for family planning (AOR = 5.19, 95% CI: 2.72–9.92) were more likely to have advanced age pregnancy. Whereas Living in an Emerging region (AOR = 0.29, 95% CI: 0.14–0.59) and living in a metropolitan city (AOR = 0.03, 95% CI: 0.03–0.38), were less likely to have advanced age pregnancy. Conclusions increased Maternal age at first birth, level of maternal education, history of alcohol drinking, increased number of parity and household members, family planning unmet need for spacing, had sons/daughters elsewhere, had higher community poverty level, those had higher community unmet need for family planning positively, whereas living in the emerging region and living in metropolitan’s city was negatively affect advanced age pregnancy. Help women to have informed decision-making and create platforms to women have special care during this age of pregnancy. Empower women on family planning and socioeconomic status.

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Association of neighborhood social determinants of health, race and ethnicity, and severe maternal morbidity on the frequency of emergency department visits and preventable emergency department visits among pregnant individuals

Holtzclaw,

Bose-Brill,

Fareed

2023

Preprint

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BackgroundThe relationship between emergency department (ED) use and SDoH (both individual or neighborhood) factors is complex, and critical factors such as racioethnicity and obstetric comorbidities may moderate this relationship among pregnant individuals. The public health implications of this complex relationship are important for pregnant women because frequent ED visits (both non-preventable and preventable) increase the likelihood of adverse maternal and infant health outcomes and resource burden to communities.MethodsOur quantitative study analyzed clinical, billing, and census data about pregnant individuals from a Tertiary Medical Center (TMC) between 2017 and 2020. To classify visits as preventable, we used an updated New York University ED algorithm. The address of the patient during their ED visit was linked to an area-level deprivation measure to represent neighborhood SDoH. Race and ethnicity data were extracted from the electronic health record and clinical diagnosis data was extracted for obstetric comorbidity ICD-10 codes related to increased risk of severe maternal morbidity (SMM). The date of a clinical diagnosis was used to determine if a specific set of comorbidities were present during a pregnancy. Other sociodemographic and clinical variables were extracted for model adjustment. A negative binomial regression was used to fit the data (n=13,357) to examine the frequency of ED and preventable ED visits based on neighborhood SDoH, race and ethnicity, obstetric comorbidity, and the interactions of these variables.ResultsAdjusted model estimates indicated that individuals who identified as non-Hispanic Black experienced higher frequency of ED use across all levels of neighborhood deprivation, and the ED use among non-Hispanic Black individuals in least deprived neighborhoods were higher than or similar to individuals who identified with other racial and ethnic groups who lived in the most deprived neighborhoods. Non-Hispanic Black individuals had the highest frequencies of ED use compared to individuals who identified with other race and ethnic groups whether SMM was present or not, and the frequencies of ED use among non-Hispanic Black individuals with an absence of obstetric comorbidity was higher than individuals who identified with other race and ethnic groups with a comorbidity. Model estimates also indicate that the probabilities of preventable ED visit did not vary race and ethnicity intersected by SDoH. Individuals with obstetric comorbidities had higher probability of a preventable ED visit compared to those not at risk of SMM regardless of different levels of SDoH opportunity. Our study quantifies these differences in estimates between neighborhood SDoH, race and ethnicity, and SMM risk.ConclusionsExamination of interventions to address higher ED use among pregnant individuals require an intersectional lens through which policymakers can gain a nuanced perspective on how ED use is influenced by SDoH, race and ethnicity, and risk of SMM among vulnerable individuals.

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National Hospital Care Survey Demonstration Projects: Severe Maternal Morbidity in Inpatient and Emergency Departments

Abstract: This report demonstrates the ability of the National Hospital Care Survey (NHCS) to examine delivery hospitalizations involving severe maternal morbidity (SMM).

Cited by 4 publications

References 19 publications

National Hospital Care Survey Demonstration Projects: Examination of Maternal Health Outcomes by Housing Assistance Status

National Hospital Care Survey Demonstration Projects: Examination of Maternal Health Outcomes by Housing Assistance Status

Determinants of advanced age pregnancy in Ethiopian; multi-level analysis of Ethiopian demographic health survey 2016

Association of neighborhood social determinants of health, race and ethnicity, and severe maternal morbidity on the frequency of emergency department visits and preventable emergency department visits among pregnant individuals

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