Intersectional inequities in maternal mortality: Examining the compounded risks for black birthing individuals with physical disabilities.
Ilhom Akobirshoev, Sarah Jerome, Jonathan M Snowden and 4 others
PMID 39643523WHAT IT FOUND
Black birthing individuals and people with physical disabilities each had higher maternal death risk during delivery hospitalization; when adjusted only for hospital and year, their combined risk exceeded the sum of separate risks.
Key findings
01Black birthing individuals had a maternal mortality rate of 14.5 per 100,000 deliveries, compared with 5.1 per 100,000 for White birthing individuals, and adjusted risk was about 2.5 times after hospital and admission year adjustment.
02Birthing individuals with physical disabilities had a maternal mortality rate of 69.7 per 100,000 deliveries, compared with 6.4 per 100,000 for peers without physical disabilities, and unadjusted risk was nearly 11 times higher.
03The combined effect of Black race and physical disability exceeded the sum of the separate effects in unadjusted analysis and after hospital and admission year adjustment, but the estimate was uncertain after adding sociodemographic and clinical factors.
STILL TO COME
How it was doneWhat they found
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What it does not show
The analysis counted delivery hospitalizations, not unique people, so someone with multiple deliveries could be included more than once. Physical disability was only identified from codes recorded during delivery hospitalization, so some disabled people may have been missed and counted as no disability. The study only counted maternal deaths during the delivery hospitalization, not deaths up to 42 days after birth, so true maternal mortality may be underestimated. Race or ethnicity was missing for 12.4% of records and those records were excluded, which may introduce bias. The data did not include some factors such as marital status, education level, or social support, which could affect the results. It was an observational analysis of administrative data, not a trial of any treatment, so it cannot show that a specific service reduced maternal mortality.
The easy way to misread this
Do not read the combined risk as fully established. The estimate that the combined effect was greater than the separate effects became uncertain after adding sociodemographic and clinical factors, and the study only counted deaths during delivery hospitalization.