Native, Black women more likely to deliver in lower quality hospitals

ByRegina Schaffer

Fact checked byCarol L. DiBerardino, MLA, ELS

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Key takeaways:

Indigenous and Black women delivered in lower quality hospitals in the U.S. compared with white women.
Data suggest the disparity could have been reduced if Black women delivered at their nearest hospital.

Native American and Black women delivered at lower quality hospitals compared with white women, with data suggesting the disparity could be reduced for Black women if they had delivered at their nearest hospital.

“Targeted interventions are needed to improve care quality at hospitals serving minoritized populations,” Nansi S. Boghossian, PhD, associate professor in the department of epidemiology and biostatistics at the University of South Carolina, told Healio. “Additionally, policies should focus on reducing segregation in health care and housing to ensure that high-quality care is accessible to all individuals, regardless of race or ethnicity.”

For the population-based study, researchers analyzed data from 6,418,635 women across 549 hospitals in five states (California, Michigan, Oregon, Pennsylvania and South Carolina), including 51.1% who identified as white, 25.6% who identified as Hispanic, 12.6% who identified as Black, 7.2% who identified as Asian and 0.2% who identified as Native American or American Indian. Researchers calculated the obstetric inequality index for Native American, Asian, Black and Hispanic women compared with white women, with hospitals ranked by their standardized morbidity ratio for nontransfusion severe maternal morbidity.

To distinguish between the hospital services available to patients and their actual delivery choices, the researchers examined disparities in care based on the hospital where delivery occurred and the closest hospital to the patient’s residential ZIP code.

“This approach is grounded in prior data suggesting that pregnant patients often deliver at the nearest hospital with delivery services,” the researchers wrote. “Thus, the quality of care at this closest hospital may serve as a proxy for the care available within that ZIP code.”

The findings were published in JAMA Network Open.

Researchers found that, compared with white women, American Indian and Black women delivered at lower quality hospitals.

Actual delivery hospital inequality indices were 0.02 (95% CI, 0.08 to 0.04) for Asian women and 0.04 (95% CI, 0.09 to 0.01) for Hispanic women, indicating no significant difference in hospital quality compared with white women. The delivery hospital inequality index was 0.07 for Native American women (95% CI, 0.03-0.11) and 0.15 for Black women (95% CI, 0.12-0.19).

Black vs. white women also lived closer to lower quality hospitals, with the closest hospital inequality index of 0.11 for Black women (95% CI, 0.07-0.14). Researchers also found that the inequality index for Black women would have been lower if those women delivered at their nearest hospital, they wrote.

“In all five states in our study, Black birthing individuals lived closer to higher quality hospitals than the hospitals they chose for delivery,” the researchers wrote. “The reasons that pregnant individuals select certain hospitals are not well understood. Area-level factors, such as geographic proximity, structural racism, insurance status and comorbidities, might be determinants of access to care. The percentage of office-based physicians accepting new Medicaid patients (69%) for example, has been shown to be lower than the percentage accepting new Medicare patients (84%) or new privately insured patients (85%), indicating that insurance type might limit access to certain hospitals that differ on quality of care provided.”