State variation in severe maternal morbidity with Medicaid linked to racial disparities

Key takeaways:

• Non-Hispanic Black women had a higher rate of severe maternal morbidity compared with non-Hispanic white women.
• Leading individual indicators of severe maternal morbidity also varied by state.

A cross-sectional analysis published in Obstetrics & Gynecology found great variation in U.S. states for severe maternal morbidity, individual indicators and higher burden among non-Hispanic Black populations.

“The objective of this study was to use the TAF (Transformed Medicaid Statistical Information System Analytic Files) from CMS data to measure rates of composite severe maternal morbidity without blood transfusion overall and by state; identify the leading individual indicators of severe maternal morbidity overall, by state and maternal race and ethnicity; and measure racial and ethnic differences in severe maternal morbidity overall and by state,” Lindsay K. Admon, MD, MSc, assistant professor in the department of obstetrics and gynecology at the Institute for Healthcare Policy and Innovation at the University of Michigan, Ann Arbor, and colleagues wrote.

This pooled, cross-sectional analysis assessed data from the 2016 to 2018 TAF and measured overall and state-level rates of severe maternal morbidity without blood transfusion for 4,807,143 live births among women with Medicaid in 49 states and Washington, D.C., between 2016 and 2018. Admon and colleagues also evaluated severe maternal morbidity rates among non-Hispanic Black and non-Hispanic white women with Medicaid in a subgroup of 27 states and Washington, D.C.

Overall, the severe maternal morbidity without blood transfusion rate was 146.2 per 10,000 deliveries. Individual state rates ranged nearly threefold, from 80.3 per 10,000 deliveries in Utah to 210.4 per 10,000 deliveries in Washington, D.C., the researchers reported. Compared with the 1,051,459 non-Hispanic white women with Medicaid included in this analysis, the 629,774 non-Hispanic Black women with Medicaid experienced a higher overall severe maternal morbidity rate (125.3 vs. 212.3 per 10,000 deliveries).

Among all women with Medicaid, the leading individual indicator of severe maternal morbidity was eclampsia, but leading indicators varied across states and by race and ethnicity. Many U.S. states had the same leading indicators among the overall, non-Hispanic Black and non-Hispanic white populations, according to the researchers. However, most states differed in leading indicators across all three groups, with eclampsia the leading indicator overall, pulmonary edema or acute heart failure the leading indicator among non-Hispanic Black women and sepsis the leading indicator among non-Hispanic white women in Texas.

“As subsequent years of the TAF become available, these data may hopefully serve as surveillance data and prove helpful in evaluating the effect of any such clinical and policy interventions aimed at reducing severe maternal morbidity and, ultimately, in-hospital maternal mortality among individuals with Medicaid insurance,” the researchers wrote.