Increased severe maternal morbidity risk in areas with racial inequities in jail rates

Key takeaways:

• Living in areas with high vs. low jail inequity was tied to higher non-blood transfusion and blood transfusion-only severe maternal morbidity odds.
• Higher odds were observed for Black and Hispanic women.

Living in counties with high jail incarceration inequities between Black and white individuals was tied to increased severe maternal morbidity risk, especially for Black and Hispanic women, researchers reported in JAMA Network Open.

“Mass incarceration is conceptualized to influence population health inequities through depleted community socioeconomic and psychosocial resources, severed social ties and heightened stress. Consequently, residing in neighborhoods affected by mass incarceration has been shown to increase the risk of various adverse mental and physical health outcomes,” Elleni M. Hailu, PhD, MPH, graduate fellow in the division of epidemiology at the School of Public Health at the University of California, Berkeley, and colleagues wrote. “A small but increasing area of empirical work has also begun to document how living in areas with greater racial inequities in incarceration rates may shape adverse birthing outcomes.”

Hailu and colleagues conducted a population-based cross-sectional study using statewide data from California on all 10,200,692 live hospital births occurring at 20 weeks gestation or later from 1997 to 2018. Researchers collected data from hospital discharge and vital statistics records linked to publicly available county-level data to evaluate the association between inequities in county-level incarceration rates for Black and white individuals and severe maternal morbidity risk.

Researchers determined incarceration inequities based on the ratio of incarceration rates of Black individuals to white individuals and categorized them as low, moderate or high.

Overall, 50.8% of births were Hispanic, 29.6% were white, 13.4% were Asian or Pacific Islander, 5.8% were Black, 0.4% were American Indian or Alaska Native and 0.1% were multiracial or of other races/ethnicities.

When adjusting for county-level socioeconomic status, living in counties with high jail incarceration inequity was associated with higher odds of non-blood transfusion severe maternal morbidity for Black (OR = 1.14; 95% CI, 1.01-1.29), Hispanic (OR = 1.24; 95% CI, 1.14-1.34) and white (OR = 1.02; 95% CI, 0.93-1.12) women compared with living in counties with lower inequities. In addition, living in counties with high jail incarceration inequity was also associated with blood transfusion-only severe maternal morbidity for Black (OR = 1.2; 95% CI, 1.01-1.42), Hispanic (OR = 1.2; 95% CI, 1.14-1.27) and white (OR = 1.09; 95% CI, 1.02-1.17) women compared with living in counties with lower inequities.

“In this study, we found that residing in counties with high jail incarceration inequity between Black and white individuals was associated with increased severe maternal morbidity risk, particularly among Black and Hispanic or Latinx birthing people,” the researchers wrote.