Wide disparities in obstetrical outcomes exist between women of different race/ethnicities. The prevalence of preterm birth, fetal growth restriction, fetal demise, maternal mortality and inadequate receipt of prenatal care all vary by maternal race/ethnicity. These disparities have their roots in maternal health behaviors, genetics, the physical and social environments, and access to and quality of health care. Elimination of the health inequities due to sociocultural differences or access to or quality of health care will require a multidisciplinary approach. We aim to describe these obstetrical disparities, with an eye towards potential etiologies, thereby improving our ability to target appropriate solutions.
Keywordsdisparities; maternal mortality; obstetrical care; preterm birth; race/ethnicity
Racial and Ethnic Disparities in Obstetrical Outcomes and Obstetrical CareProfound racial and ethnic disparities have been documented in many areas of health and health care [1][2][3] . Attempts to rectify these inequities in outcomes and processes of care must begin with an accurate account of their prevalence, and with some attention to potential etiologies. Unfortunately, disparities in obstetrical outcomes and care have persisted over time [4][5][6] . Here, we aim to summarize these obstetrical disparities and their possible origins, with the hope of driving an agenda to resolve them.The manner in which disparities in health and health care should be defined is not always straightforward. In an argument to standardize the definition, Lê Cook and colleagues describe three definitions of disparities in health care. 7 In the first, proposed by the Agency for Healthcare Research and Quality, disparities are defined by the mathematical difference in means or proportions between groups, without the use of statistical models. In the second, the Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
CondensationWidespread racial/ethnic disparities exist in obstetrics; documenting them and understanding potential etiologies will increase the likelihood of eliminating them.
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Author ManuscriptAm J Obstet Gynecol. Author manuscript; available in PMC 2011 April 1.
NIH-PA Author ManuscriptResidual Direct Effect method, disparities are defined by differences which persist after accounting for all measured potential confounding variables. The last definition, preferred by the authors, is that used by the Institute of Medicine, in which disparities are seen as differences above and beyond those that can be explained by differences in health status between groups. Thus f...
No outside funding supported this research. All authors are full-time employees of Quintiles, which provides research and consulting services to the biopharmaceutical industry. The authors have no other disclosures to report. Two of the 3 CART trees were presented at the International Society of Pharmacepidemiology in 2015 ("Article Citations per Year" and "Journal Impact Factor"). The original validation study was published in the March 2014 issue of the Journal of Managed Care & Specialty Pharmacy. The checklist questions and scoring were included using a table that was originally published by this journal in 2014. Study concept and design were primarily contributed by Dreyer and Velentgas, along with Bryant. Bryant took the lead in data collection and analysis, along with Dreyer and Velentgas, and data interpretation was performed by Dreyer, Velentgas, and Bryant. The manuscript was written and revised primarily by Dreyer, along with Bryant and Velentgas.
Racial and ethnic disparities exist in both perinatal outcomes and health care quality. For example, black women are 3 to 4 times more likely to die from pregnancy-related causes and have more than a 2-fold greater risk of severe maternal morbidity than white women. In an effort to achieve health equity in maternal morbidity and mortality, a multidisciplinary workgroup of the National Partnership for Maternal Safety, within the Council on Patient Safety in Women's Health Care, developed a concept article for the bundle on reduction of peripartum disparities. We aimed to provide health care providers and health systems with insight into racial and ethnic disparities in maternal outcomes, the etiologies that are modifiable within a health care system, and resources that can be used to address these etiologies and achieve the desired end of safe and equitable health care for all childbearing women.
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