Understanding racial disparities in severe maternal morbidity using Bayesian network analysis

Rezaeiahari, Mandana; Brown, Carrie M.; Ali, Mir M.; Datta, Jyotishka; Tilford, John M.

doi:10.1371/journal.pone.0259258

Cited by 4 publications

(1 citation statement)

References 46 publications

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“…Research has indicated that prepregnancy obesity is a potential limited driver of SMM disparities [44]. A Bayesian network analysis using an Arkansas All-Payer Claims Database (2013–2017) found that anemia and hypertensive disorders of pregnancy are important clinical comorbidities associated with SMM; both conditions were associated with Black race [45]. Mixed-effects linear regression model analysis (with adjustment for predefined covariates associated with blood pressure) of postpartum blood pressure trajectories among women with hypertensive disorders of pregnancy found that Black women had a less rapid decrease in postpartum blood pressure, which resulted in 68.1% of Black women compared with 51.4% of White women meeting the criteria for stage 1 or stage 2 hypertension by the end of a 6-week program [46].…”

Section: Risk Indicators For Obstetrical Disparitiesmentioning

confidence: 99%

Obstetric and perinatal racial and ethnic disparities

White

Aaronson

2022

Current Opinion in Anaesthesiology

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Purpose of reviewHealthcare disparities are health differences that adversely affect disadvantaged populations. In the United States, research shows that women of color, in particular Black and Hispanic women and their offspring, experience disproportionately higher mortality, severe maternal morbidity, and neonatal morbidity and mortality. This review highlights recent population health sciences and comparative effectiveness research that discuss racial and ethnic disparities in maternal and perinatal outcomes. Recent findingsEpidemiological research confirms the presence of maternal and neonatal disparities in national and multistate database analysis. These disparities are associated with geographical variations, hospital characteristics and practice patterns, and patient demographics and comorbidities. Proposed solutions include expanded perinatal insurance coverage, increased maternal healthcare public funding, and quality improvement initiatives/efforts that promote healthcare protocols and practice standardization. SummaryObstetrical healthcare disparities are persistent, prevalent, and complex and are associated with systemic racism and social determinants of health. Some of the excess disparity gap can be explained through community-, hospital-, provider-, and patient-level factors. Providers and healthcare organizations should be mindful of these disparities and strive to promote healthcare justice and patient equity. Several solutions provide promise in closing this gap, but much effort remains.

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Section: Risk Indicators For Obstetrical Disparitiesmentioning

confidence: 99%

Obstetric and perinatal racial and ethnic disparities

White

Aaronson

2022

Current Opinion in Anaesthesiology

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Risk of recurrent severe maternal morbidity in an urban safety-net health system

Boulet¹,

Stanhope²,

Worrell³

et al. 2022

American Journal of Obstetrics & Gynecology MFM

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Iron deficiency resolution and time to resolution in an American health system

Cogan,

Meyer,

Jiang

et al. 2024

Blood Advances

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Iron deficiency (ID) is a global health problem with consequences independent of anemia, including impaired cognition and exercise tolerance. The time from laboratory diagnosis to resolution of ID has not been defined. In a retrospective review of electronic medical record data from a Minnesota statewide health system, we identified patients with ID (ferritin level < 25 ng/mL). Patients with at least one follow-up ferritin level within 3 years were included. Patients with a subsequent ferritin > 50 ng/mL were classified as having resolved ID. Descriptive statistics and time-to-event analyses were used to determine proportion of ID resolution and time to resolution, and to evaluate characteristics predictive of resolution. We identified 13,084 patients with ID between 2010 to 2020. We found that 5,485 (41.9%) had resolution within 3 years of diagnosis, while 7,599 (58.1%) had no documented resolution. The median time to resolution was 1.9 years (IQR 0.8, 3.9 years). Factors associated with greater likelihood of resolution included age 60 years and older (aHR 1.56 [95% CI 1.44 - 1.69]), male sex (1.58 [95% CI 1.48 - 1.70]) and treatment with intravenous iron (2.96 [95% CI 2.66 - 3.30]). Black race was associated with a lower likelihood of resolution (0.73 [95% CI 0.66 - 0.80]). We observed a high proportion of persistent ID and prolonged time to resolution overall, with greater risk of lack of resolution among females and black individuals. Targeted knowledge translation interventions are required to facilitate prompt diagnosis and definitive treatment of this prevalent and correctable condition.

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Understanding racial disparities in severe maternal morbidity using Bayesian network analysis

Cited by 4 publications

References 46 publications

Obstetric and perinatal racial and ethnic disparities

Obstetric and perinatal racial and ethnic disparities

Risk of recurrent severe maternal morbidity in an urban safety-net health system

Iron deficiency resolution and time to resolution in an American health system

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