711 Obstetric comorbidity index corresponds with racial disparity in maternal morbidity providing insight for risk reduction

Abstract

The obstetric comorbidity index (OCI) score, a weighted aggregation of pre-delivery maternal comorbidities known as OCI indicators, has been validated in predicting non-transfusion severe maternal morbidity (ntSMM). We sought to determine whether OCI corresponds with racial disparities in ntSMM and help to identify areas for risk reduction. This retrospective analysis included all deliveries in a four-hospital system from January 2016 through January 2020. Demographic and clinical data were extracted using an automated query from the hospital electronic data warehouse. Utilizing the methodology reported in Leonard et al, 2020, we calculated and compared OCI scores between races/ethnicities (R/E). The average weighted contribution of each OCI indicator was then calculated by multiplying each score by the prevalence of the indicator within each R/E. The overall percentage of subjects with ntSMM and the incidence of each ntSMM per 10,000 deliveries was tabulated by R/E for comparison to OCI profiles. Of the 60,034 births, 36.8% were White, 19.4% Hispanic, 14.8% Asian, 14.0% unknown/other, 8.3% Black, 6.3% declined to answer. Black subjects had the highest average OCI score at 8.9 and highest percentage with ntSMM at 2.1% (Fig 1), with the highest contributions to the OCI from anemia, preterm birth (PTB) and preeclampsia (PEC) (Fig 2). Hispanic subjects and subjects of unknown R/E had the second highest OCI score and percentage with ntSMM at 1.1% (Fig 1) with the highest contributions from anemia, PTB and PEC, though at lower rates than Black subjects (Fig 2). The specific types of ntSMM also differed by R/E. The most prevalent ntSMM for Black and Hispanic subjects included acute renal failure, hysterectomy and disseminated intravascular coagulation. The OCI score corresponded with racial disparity in ntSMM highlighting disparities in specific maternal comorbidities by which we can target interventions. As PTB, anemia and PEC correspond with ntSMM in Black and Hispanic subjects, interventions targeting these conditions should be prioritized to reduce racial disparity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)