Dataset Information

Racial disparities in care escalation for postpartum hemorrhage requiring transfusion.

ABSTRACT:

Background

Postpartum hemorrhage is a leading cause of maternal morbidity and mortality in the United States and disproportionately affects pregnant persons of color.

Objective

This study aimed to identify the demographic and obstetrical characteristics of those who received different levels of antihemorrhagic intervention in the setting of severe postpartum hemorrhage requiring blood transfusion.

Study design

This was a retrospective cohort study of patients with documented postpartum hemorrhage (estimated blood loss of ≥1000 mL) and blood product transfusion. Moreover, 3 levels of antihemorrhagic intervention were defined as follows: level 1, administration of uterotonics only; level 2, performance of a procedure (ie, B-Lynch suture, O'Leary stitch, Bakri balloon, dilation and curettage, laceration repair, or embolization); and level 3, hysterectomy. Maternal demographics, obstetrical characteristics, and comorbidities were extracted from electronic health records. Ordinal logistic regression was used to estimate the odds of higher intervention levels adjusting for maternal demographic and obstetrical characteristics.

Results

Of note, 365 patients were included in this study, with a racial or ethnic composition of 30% White, 42% Black, 18% Hispanic, and 10% other. Moreover, 233 patients (64%) received level 1 intervention, 98 patients (27%) received level 2 intervention, and 34 patients (9%) received level 3 intervention. Patients receiving higher levels of intervention were more likely to have greater estimated blood loss (P<.001), have more transfusions (P<.001), and be of advanced maternal age (P=.004). Black and Hispanic patients were less likely to have received higher levels of intervention than White patients (P=.034). After adjusting for estimated blood loss, advanced maternal age, placenta accreta spectrum, and fibroids, Black patients remained significantly less likely to receive higher levels of intervention (adjusted odds ratio, 0.55; 95% confidence interval, 0.30-0.98). This difference persisted at an estimated blood loss of ≥3000 mL, with Black and Hispanic patients being significantly less likely to receive higher levels of intervention than White patients (odds ratio, 0.31 [95% confidence interval, 0.10-0.92] and 0.10 [95% confidence interval, 0.01-0.53], respectively).

Conclusion

Among patients experiencing postpartum hemorrhage and receiving transfusion, Black patients are less likely to receive higher levels of antihemorrhagic intervention. This disparity is concerning in this high-risk population and requires further attention and investigation.

SUBMITTER: Guan CS

PROVIDER: S-EPMC10481353 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Racial disparities in care escalation for postpartum hemorrhage requiring transfusion.

Guan Carolyn S CS Boyer Theresa M TM Darwin Kristin C KC Henshaw Chelsea C Michos Erin D ED Lawson Shari S Vaught Arthur J AJ

American journal of obstetrics & gynecology MFM 20230321 6

<h4>Background</h4>Postpartum hemorrhage is a leading cause of maternal morbidity and mortality in the United States and disproportionately affects pregnant persons of color.<h4>Objective</h4>This study aimed to identify the demographic and obstetrical characteristics of those who received different levels of antihemorrhagic intervention in the setting of severe postpartum hemorrhage requiring blood transfusion.<h4>Study design</h4>This was a retrospective cohort study of patients with documente ...[more]

PMID: 36948294

Similar Datasets

Project description:ObjectiveTo evaluate racial and ethnic differences in women's postpartum pain scores, inpatient opioid administration, and discharge opioid prescriptions.MethodsWe conducted a retrospective cohort study of all deliveries at a single high-volume tertiary care center from December 1, 2015, through November 30, 2016. Women were included if they self-identified as non-Hispanic white, non-Hispanic black, or Hispanic; were at least 18 years of age; and did not have documented allergies to nonsteroidal antiinflammatory drugs or morphine. Medical records were queried for three outcomes: 1) patient-reported postpartum pain score (on a scale of 0-10) at discharge (dichotomized less than 5 or 5 or higher), 2) inpatient opioid dosing during postpartum hospitalization (reported as morphine milligram equivalents [MMEs] per postpartum day), and 3) receipt of an opioid prescription at discharge. The associations between each of these outcomes and maternal race-ethnicity were assessed using multivariable logistic regression models with random effects to account for clustering by discharge physician. A sensitivity analysis was conducted in which women of different race and ethnicity were matched using propensity scores.ResultsA total of 9,900 postpartum women were eligible for analysis. Compared with non-Hispanic white women, Hispanic and non-Hispanic black women had significantly greater odds of reporting a pain score of 5 or higher (adjusted odds ratio [aOR] 1.61, 95% 1.26-2.06 and aOR 2.18, 95% 1.63-2.91, respectively) but received significantly fewer inpatient MMEs/d (adjusted β -5.03, 95% CI -6.91 to -3.15, and adjusted β -3.54, 95% CI -5.88 to -1.20, respectively). Additionally, Hispanic and non-Hispanic black women were significantly less likely to receive an opioid prescription at discharge (aOR 0.80, 95% CI 0.67 to -0.96 and aOR 0.78, 95% CI 0.62-0.98) compared with non-Hispanic white women. Results of the propensity score analysis largely corroborated those of the primary analysis, with the exception that the difference in inpatient MMEs/d between non-Hispanic white and non-Hispanic black women did not reach statistical significance.ConclusionHispanic and non-Hispanic black women experience disparities in pain management in the postpartum setting that cannot be explained by less perceived pain.

Project description:ImportanceNon-Hispanic Black individuals are disproportionally covered by Medicaid during pregnancy and, compared with non-Hispanic White individuals, have higher rates of postpartum coverage loss and mortality. Expanded Medicaid coverage under the Affordable Care Act may have increased continuity of coverage and access to care in the critical postpartum period in expansion states.ObjectiveTo examine the association of Medicaid expansion in Arkansas with continuous postpartum coverage, postpartum health care use, and change in racial disparities in the study outcomes.Design setting and participantsThis cohort study with a difference-in-differences analysis compared persons with Medicaid and commercially financed childbirth, stratified by race, using Arkansas' All-Payer Claims Database for persons with a childbirth between 2013 and 2015. Race and ethnicity from birth certificate data were classified as Hispanic, non-Hispanic Black (hereafter Black), non-Hispanic White (hereafter White), and other (including Asian, Native American or Alaska Native, and Pacific Islander) or unknown race. Data were analyzed between June 2020 and August 2021.ExposuresMedicaid-paid childbirth after January 1, 2014.Main outcomes and measuresContinuous health insurance coverage and the number of outpatient visits during the first 6 months postpartum.ResultsA total of 60 990 childbirths (mean [SD] age of birthing person, 27 [5.3] years; 67% White, 22% Black, and 7% Hispanic) were included, among which 72.3% were paid for by Medicaid and 27.7% were paid for by a commercial payer. Medicaid expansion in Arkansas was associated with a 27.8 (95% CI, 26.1-29.5) percentage point increase in continuous insurance coverage and an increase in outpatient visits of 0.9 (95% CI, 0.7-1.1) during the first 6 months postpartum, representing relative increases of 54.9% and 75.0%, respectively. Racial disparities in postpartum coverage decreased from 6.3 (95% CI, 3.9-8.7) percentage points before expansion to -2.0 (95% CI, -2.8 to -1.2) percentage points after expansion. However, disparities in outpatient care between Black and White individuals persisted after Medicaid expansion (preexpansion difference, 0.4 [95% CI, 0.2-0.6] visits; postexpansion difference, 0.5 [95% CI, 0.4-0.6] visits).Conclusions and relevanceIn this cohort study with a difference-in-differences analysis of 60 990 childbirths, Medicaid expansion was associated with higher rates of postpartum coverage and outpatient visits and lower racial and ethnic disparities in postpartum coverage. However, disparities in outpatient visits between Black and White individuals were unchanged. Additional policy approaches are needed to reduce racial and ethnic disparities in postpartum care.

Project description:ImportanceRacial and ethnic disparities in postpartum care access have been well identified in the United States. Such disparities could be exacerbated by the COVID-19 pandemic because of amplified economic distress and compromised social capital among pregnant women who belong to racial or ethnic minority groups.ObjectiveTo examine whether the COVID-19 pandemic is associated with an increase in the existing racial and ethnic disparity in postpartum care access.Design, setting, and participantsThis was a retrospective cohort study using electronic health records data. Multinomial logistic regressions in an interrupted time series approach were used to assess monthly changes in postpartum care access across Asian, Hispanic, non-Hispanic Black (hereafter, Black), non-Hispanic White (hereafter, White) women, and women of other racial groups, controlling for maternal demographic and clinical characteristics. Eligible participants were women who gave live birth at 8 hospitals in the greater Boston, Massachusetts, area from January 1, 2019, to November 30, 2021, allowing for tracking 90-day postpartum access until March 1, 2022.ExposuresDelivery period: prepandemic (January to December 2019), early pandemic (January to March 2020), and late pandemic (April 2020 to November 2021).Main outcomes and measuresPostpartum care within 90 days after childbirth was categorized into 3 groups: attended, canceled, and nonscheduled.ResultsA total of 45 588 women were included. Participants were racially and ethnically diverse (4735 [10.4%] Asian women, 3399 [7.5%] Black women, 6950 [15.2%] Hispanic women, 28 529 [62.6%] White women, and 1269 [2.8%] women of other race or ethnicity). The majority were between 25 and 34 years of age and married and had a full-term pregnancy, vaginal delivery, and no clinical conditions. In the prepandemic period, the overall postpartum care attendance rate was 75.2%, dropping to 41.7% during the early pandemic period, and rebounding back to 60.9% in the late pandemic period. During the months in the late pandemic, the probability of not scheduling postpartum care among Black (average marginal effect [AME], 1.1; 95% CI, 0.6-1.6) and Hispanic women (AME, 1.3; 95% CI, 0.9-1.6) increased more than among their White counterparts.Conclusions and relevanceIn this cohort study of postpartum care access before and during the COVID-19 pandemic, racial and ethnic disparities in postpartum care were exacerbated following the onset of the COVID-19 pandemic, when postpartum care access recovered more slowly among Black and Hispanic women than White women. These disparities require swift attention and amelioration to address barriers for these women to obtain much needed postpartum care during this pandemic.

Project description:BackgroundDespite well-documented racial disparities in maternal health in the United States, gaps remain in characterizing the distribution of these disparities in maternal blood transfusion.ObjectiveTo assess racial disparities in maternal blood transfusion using detailed, self-identified racial groupings in the United States overall and stratified by mode of delivery.Study designWe performed a population-based, retrospective cohort study of full term, live births (2016-2021) using the National Vital Statistics System's Natality Files. Regression models were constructed to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of maternal blood transfusion by self-identified maternal race in the total population, and among subgroups stratified by mode of delivery. Models were adjusted for maternal and obstetric practice factors.ResultsThe study included 17,905,699 deliveries; maternal blood transfusion occurred in 3.4 per 1,000 deliveries. Compared with individuals who identified as White (3.3 per 1,000 transfusion rate), higher odds of transfusion were found among those who identified as American Indian and Alaska Native (AIAN; aOR 2.36, 95% CI 2.23-2.49), Black (aOR 1.15, 95% CI 1.12-1.17), Filipino (aOR 1.33, 95% CI 1.22-1.44), Korean (aOR 1.25, 95% CI 1.10-1.42), and Pacific Islander (aOR 1.63, 95% CI 1.45-1.83). The frequency of transfusion and racial disparities in transfusion varied substantially by mode of delivery. Lower rates of transfusion in Black vs White patients were observed in the spontaneous vaginal delivery (2.2 vs 2.3 per 1000; aOR 0.95, 95% CI 0.92-0.99), forceps (6.8 vs 8.9 per 1000; aOR 0.77, 95% CI 0.60-0.99), vacuum (4.2 vs 5.0 per 1000; aOR 0.85, 95% CI 0.74-0.97, and cesarean delivery with trial of labour (8.8 vs 8.9 per 1000; aOR 0.95, 95% CI 0.91-1.00) groups, while a higher rate was shown among cesarean deliveries without trial of labour (6.8 vs 4.3 per 1000; aOR 1.45, 95% CI 1.40-1.51).ConclusionRacial disparities in maternal blood transfusion persist after adjustment for several confounders, particularly for AIAN and Pacific Islander individuals, and vary by mode of delivery.

Dataset Information

Racial disparities in care escalation for postpartum hemorrhage requiring transfusion.

Background

Objective

Study design

Results

Conclusion

Publications

Racial disparities in care escalation for postpartum hemorrhage requiring transfusion.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets