Racial and ethnic disparities in severe maternal morbidity and anesthetic techniques for obstetric deliveries: A multi-state analysis, 2007-2014

Study objective: To evaluate racial and ethnic disparities in severe maternal morbidity (SMM) and administered anesthesia techniques. Design: Retrospective cohort study. Setting: Administrative database study using 2007-2014 data from California, Florida, New York, Maryland, and Kentucky from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ). Patients: 6,879,332 parturients aged >= 18 years old who underwent deliveries were identified by International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes: V27.0 and V27.1 for singleton deliveries, and V27.2 through V27.8 for multiple births. Interventions: Patients who had a singleton or multiple delivery. Measurements: Patients were cohorted by race/ethnicity: white (reference category), black, Hispanic, other, or missing. Demographic characteristics and comorbidities were compared. Adjusted odds ratios with generalized linear mixed modeling were calculated for SMM. We also conducted additional exploratory analyses of racial/ ethnic disparities in the anesthesia technique used for cesarean deliveries, as well as the use of analgesia in vaginal deliveries. Main results: When controlling for patient demographics, comorbidities, and hospital characteristics, black women were more likely than white women to experience any SMM (adjusted odds ratio: 1.38, 95% CI: 1.35-1.41). This finding was consistent in stratified analyses. Black women were also more likely than white women to receive general anesthesia for cesarean delivery (aOR: 1.44, 95% CI: 1.39-1.49) and to receive no analgesia for vaginal delivery (aOR: 1.45, 95% CI: 1.43-1.47). Conclusions: Our findings highlight the differences in outcomes and care for black as compared to white parturients related to SMM and administered anesthesia techniques.