1162 Relationship of maternal-fetal medicine specialist density with maternal mortality ratios between 2010 and 2018

Abstract

With the increase in maternal mortality and morbidity in the United States, it is imperative to understand what aspect Maternal-Fetal Medicine provider density has on this. Our study’s objective was to determine the relationship between state-specific maternal mortality ratios and the density of Maternal-Fetal Medicine specialists. State maternal mortality ratios from 2010 to 2018 were calculated from the Centers for Disease Control National Center for Health Statistics database (Maternal mortality defined as maternal deaths within a year following pregnancy). Practitioner distribution data were obtained from professional associations and national provider information. Demographic information regarding states was gathered from the yearly American Community Survey (ACS). Bivariable and multivariable analyses were conducted with the use of Spearman correlations and Poisson regression, respectively. Our primary outcome was a measure of maternal mortality ratios correlated with Maternal-Fetal Medicine physician density. The median state maternal-mortality ratio was 17.4/100,000 live births (increased significantly from 7.5/100,000 livebirths for years 1994-2001). Our study showed that an increase of 4 maternal-fetal specialists per 10,000 live births results in a 20% reduction in the risk of maternal death (relative risk [RR] =0.63, 95% CI = 0.31- 0.81, p = 0.04). This risk reduction was based on a multivariable Poisson regression model that included the following variables and their significant interactions: state-specific percentages of mothers in poverty, mothers without a high school diploma and minority mothers. The maternal mortality rate has significantly increased over the last 10 years, even doubling when compared to a prior analysis done in 2001. The density of maternal-fetal medicine specialists is significantly and inversely associated with maternal mortality ratios, even after controlling for state-level measures of maternal poverty, education, race, age, and their significant interactions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)