Variation in Severe Maternal Morbidity Among Black and White Medicaid Enrollees in 27 States [ID: 1368013

Abstract

INTRODUCTION: Interventions designed to address high rates of severe maternal morbidity (SMM) and improve maternal health equity often lack comprehensive data on the relative burden of specific SMM indicators across populations. This study examines variation in indicators of delivery-related SMM among non-Hispanic Black compared with non-Hispanic White Medicaid beneficiaries in 27 states. METHODS: We conducted a pool, cross-sectional analysis of the 2016–2018 Transformed Medicaid Statistical Information System. Unadjusted estimates of indicator frequency were generated for 27 states with adequate quality data on non-Hispanic Black and non-Hispanic White race and ethnicity. We estimated rates for each indicator for each racial group overall and within each state. This study was approved by the IRB at Boston University. RESULTS: Among deliveries to the non-Hispanic Black population (n=629,774), six indicators occurred at overall rates greater than 25 per 10,000 deliveries: eclampsia (leading indicator in 15 states), pulmonary edema/heart failure (3 states), renal failure (1 state), adult respiratory distress syndrome (3 states), sepsis (2 states), and disseminated intravascular coagulation (2 states). Among deliveries to the non-Hispanic White population (n=1,051,459), indicators occurred in different rank-order and at rates typically less than half of those identified among the non-Hispanic Black population. Morbidity indicators among the non-Hispanic White population were distributed differently across states. CONCLUSION: These findings provide opportunities for interventions designed to reduce SMM and improve maternal health equity in Medicaid to be tailored to the leading causes of SMM, which differ among non-Hispanic Black and White populations across and within states.