23 Race Matters: Maternal Morbidity in the Military Health System

Abstract

In the United States, Black women are 3-4 times more likely to die from childbirth, and have a twofold greater risk of maternal morbidity than their White counterparts. This disparity is theorized to be due to differences in access to health care and/or socioeconomic status. Military service members and their dependents are a diverse community and have equal access to healthcare and similar socioeconomic statuses. We hypothesize that universal access to health care, as seen in the military health care system, leads to similar rates of maternal morbidity regardless of race. We reviewed data from the Neonatal Perinatal Information Center special report from April 1 2018 through March 31 2019 on severe maternal morbidity by race in participating military treatment facilities (MTFs) that performed more than 1000 deliveries per year for our retrospective cohort study. Chi squared tests compared the percentages of cesarean deliveries, adult ICU admissions, and severe maternal morbidity between Black and White patients. There were a total of 23,728 deliveries with 15,305 encompassing self-identified Black and White women (23 vs. 77%). A total of 282 women experienced SMM with 38 adult ICU admissions and 190 postpartum hemorrhages. Black women were more likely to have a delivery via cesarean section (31.68% vs 23.58%, P value <0.0001), be admitted to an adult ICU (0.49% vs 0.18%, P value 0.0026), and experience overall SMM (2.66% vs 1.66%, P value 0.0001) compared to their White counterparts. Additionally, Black women were more likely to experience SMM when excluding blood transfusion (0.64% vs 0.32%, P value 0.0139). There was no significant difference between races in overall SMM among postpartum hemorrhage cases or when excluding blood transfusion. Equal access to care and socioeconomic status do not explain the healthcare disparities encountered by Black women having children in the United States. Further studies to assess causes such as systemic racism (including implicit and explicit medical biases) and physiologic factors are warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)