Risk for severe maternal morbidity varies across neighborhoods

Severe maternal morbidity (SMM) is higher for women in ZIP codes with the highest concentration of poor blacks relative to wealthy whites, which is partially attributable to the delivery hospital, according to a study published in the May issue of Health Affairs.

Teresa Janevic, M.P.H., Ph.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues used linked New York City birth and hospitalization data for 2012 to 2014 to examine the correlation between racial and economic spatial polarization with SMM rates and the impact of delivery hospitals on this association.

The researchers found 4.0 cases of SMM per 100 deliveries for women in ZIP codes with the highest concentration of poor blacks relative to wealthy whites compared with 1.7 cases per 100 deliveries among women in neighborhoods with the lowest concentration (risk difference, 2.4 cases per 100). The delivery hospital accounted for 35 percent of this difference. Women who lived in highly polarized neighborhoods were most likely to deliver in hospitals located in similarly polarized neighborhoods (32 percent compared with 1 percent of women living in neighborhoods with a high relative concentration of whites).

"The combination of racial and economic spatial polarization is associated with severe maternal morbidity in New York City," the authors write. "Policies addressing racial and economic segregation, health promotion in highly polarized neighborhoods, and quality improvement in hospitals that serve these neighborhoods are needed."

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