Relationship Between Neighborhood Socioeconomic Disadvantage and Severe Maternal Morbidity and Maternal Mortality

Background: Rates of severe maternal mor­bidity and maternal mortality (SMM/MM) in the United States are rising. Disparities in SMM/MM persist by race, ethnicity and geography, and could partially be attributed to social determinants of health.Purpose: Utilizing data from the largest, statewide referral hospital in Alabama, we investigated the relationship between residence in disadvantaged neighborhoods and SMM/MM.Methods: Data on all pregnancies between 2010 and 2020 were included; SMM/MM cases were identified using CDC definitions. Area deprivation index (ADI) available at the census-block group was geographically linked to individual records and categorized using quintile cutoffs; higher ADI score indi­cated higher socioeconomic disadvantage. Generalized estimating equation models were used to adjust for spatial autocorrela­tion and ORs were computed to evaluate the relationship between ADI and SMM/ MM, adjusted for covariates including age, race, insurance, residence in medically underserved areas/population (MUAP), and urban/rural residence.Results: Overall, 32,909 live-birth deliveries were identified, with a prevalence of 9.8% deliveries with SMM/MM with blood trans­fusion and 5.3% without blood transfusion, respectively. Increased levels of ADI were associated with increased odds of SMM/ MM. Compared to women in the lowest quintile, the adjusted OR for SMM/MM among women in highest quintile was 1.78 (95%CI, 1.22-2.59, P=.0027); increas­ing age, non-Hispanic Black, government insurance and residence in MUAP were also significantly associated with increased odds of SMM/MM.Conclusion: Our results suggest that resi­dence within disadvantaged neighborhoods may contribute to SMM/MM even after adjusting for patient-level factors. Measures such as ADI can help identify the most vulnerable populations and provide points to intervene.Ethn Dis.2022;32(4):293-304; doi:10.18865/ed.32.4.293