722 Perinatal outcomes among women living in at-risk areas identified by a community health needs assessment

Abstract

As a recent Community Health Needs Assessment (CHNA) identified geographic areas within our county with substantial health disparities, the aim of this study was to evaluate maternal and infant outcomes within the region. We hypothesized that perinatal outcomes would differ for women living in areas with the higher social needs compared to those living in other regions of the county. This was a retrospective cohort study of pregnant women delivering at a large inner-city county hospital, which serves as the safety net hospital for the county. Perinatal outcomes were analyzed for women living within a target region of ten zip codes, identified during a recent CHNA, and compared to those women living outside the target region. Statistical analysis included student’s t-test, chi square, and logistic regression to adjust for demographics. Between January 2015 and July 2020, 66,936 women delivered at the county hospital. Of these, a total of 7,585 (11%) resided in the CHNA target region. The women living in the target region were younger (26.8 + 6.5 vs 27.9 + 6.4 years, p<.001), more likely to be black (37% vs 13%, p<.001), and had a higher BMI (33.3 + 7.0 vs 32.6 + 6.4 kg/m2,p <.001). The rates of preeclampsia and abruption were higher in the target region (Table). Adverse infant outcomes were also more common including preterm birth, neonatal ICU admission, and neonatal death. Increased risk for all maternal and neonatal adverse outcomes persisted after adjustment for age, race, and BMI (figure). Women living in areas with higher health disparity and more social needs identified in a recent CHNA are at greater risk of adverse perinatal outcomes. Efforts to improve obstetric outcomes in this at-risk area should focus on achieving health equity by eliminating social disparities through targeted education and outreach.View Large Image Figure ViewerDownload Hi-res image Download (PPT)