Racial and Urbanicity/Rurality Disparities in Severe Maternal Morbidity, Georgia, 2016-2022
Abstract
Background: Severe maternal morbidity (SMM) is a life-threatening outcome of childbirth with significant health consequences. For every Georgia pregnancy-related death, 29 birthing persons experienced SMM during 2018-2020. Maternal mortality (MM) surveillance is well established and has contributed to identification of race/ethnicity and residential rurality among national MM risk factors. Better understanding these factors and their association with SMM is important for preventing SMM and MM in Georgia.
Methods: Using Georgia hospital discharge data and the American College of Obstetricians and Gynecologists SMM algorithm, we identified severe outcomes, excluding blood transfusions, among 2016-2022 delivery hospitalizations. Using four race/ethnicity categories and six county urbanicity categories (Level 1: most urban; Level 6: most rural), we calculated two categories of rate ratios: 1) race/ethnicity, with non-Hispanic White as reference, and 2) urbanicity/rurality, with Level 1 as reference.
Results: We identified 7,650 cases of SMM among 860,661 deliveries for 2016-2022. The aggregate SMM rate was highest among Black birthing persons and lowest among White birthing persons (RR=1.81). SMM was highest in urban counties and lowest for intermediate urbanicity (RR=0.70, Level 4 vs. 1). For urbanicity disaggregated by race, Black birthing persons had the highest rate in every urbanicity level (RR range: 1.44 for Level 5; 2.52 for Level 1). Among only Black birthing persons, SMM was highest in urban counties (RR=0.83, Level 6 vs. 1), whereas among White birthing persons, SMM was highest in rural counties (RR=1.40, Level 6 vs. 1).
Conclusions: Non-Hispanic Black birthing persons experience the highest SMM in Georgia whether they live in urban or rural counties, and their SMM is highest in urban counties. For White birthing persons, the pattern differs, with SMM highest in rural counties. Improved Georgia SMM surveillance is important for understanding these differences to inform and prioritize equitable interventions.
Keywords: Maternal Health, Rural Health, Disparities
Keywords
Maternal Health, Rural Health, Disparities
Racial and Urbanicity/Rurality Disparities in Severe Maternal Morbidity, Georgia, 2016-2022
Background: Severe maternal morbidity (SMM) is a life-threatening outcome of childbirth with significant health consequences. For every Georgia pregnancy-related death, 29 birthing persons experienced SMM during 2018-2020. Maternal mortality (MM) surveillance is well established and has contributed to identification of race/ethnicity and residential rurality among national MM risk factors. Better understanding these factors and their association with SMM is important for preventing SMM and MM in Georgia.
Methods: Using Georgia hospital discharge data and the American College of Obstetricians and Gynecologists SMM algorithm, we identified severe outcomes, excluding blood transfusions, among 2016-2022 delivery hospitalizations. Using four race/ethnicity categories and six county urbanicity categories (Level 1: most urban; Level 6: most rural), we calculated two categories of rate ratios: 1) race/ethnicity, with non-Hispanic White as reference, and 2) urbanicity/rurality, with Level 1 as reference.
Results: We identified 7,650 cases of SMM among 860,661 deliveries for 2016-2022. The aggregate SMM rate was highest among Black birthing persons and lowest among White birthing persons (RR=1.81). SMM was highest in urban counties and lowest for intermediate urbanicity (RR=0.70, Level 4 vs. 1). For urbanicity disaggregated by race, Black birthing persons had the highest rate in every urbanicity level (RR range: 1.44 for Level 5; 2.52 for Level 1). Among only Black birthing persons, SMM was highest in urban counties (RR=0.83, Level 6 vs. 1), whereas among White birthing persons, SMM was highest in rural counties (RR=1.40, Level 6 vs. 1).
Conclusions: Non-Hispanic Black birthing persons experience the highest SMM in Georgia whether they live in urban or rural counties, and their SMM is highest in urban counties. For White birthing persons, the pattern differs, with SMM highest in rural counties. Improved Georgia SMM surveillance is important for understanding these differences to inform and prioritize equitable interventions.
Keywords: Maternal Health, Rural Health, Disparities
