Racial, Ethnic, and Economic Disparities in the Prevalence of Pregnancy Complications

Whitehead, Nedra; Callaghan, William M.; Johnson, Chris; Williams, Letitia

doi:10.1007/s10995-008-0344-2

Cited by 26 publications

(23 citation statements)

References 26 publications

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“…Previous research has shown that low-income individuals have higher preterm birth (PTB) and low birth weight (LBW) rates [3-7]. In addition, non-Hispanic African Americans compared to Non-Hispanic whites consistently have had at least twice the rate of LBW babies and 1.5 times the rate of PTBs [8], and previous studies controlling for socioeconomic status (SES) factors show racial disparities persist [9-11]. …”

Section: Introductionmentioning

confidence: 99%

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings

Kent

McClure

Zaitchik

et al. 2013

BMC Pregnancy Childbirth

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BackgroundSignificant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban–rural status.MethodsAlabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined.ResultsPopulation dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991–2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors.ConclusionsPopulation dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching isolated rural areas.

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Section: Introductionmentioning

confidence: 99%

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings

Kent

McClure

Zaitchik

et al. 2013

BMC Pregnancy Childbirth

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“…Under the Taiwan NHI program all pregnant women are allowed to have 10 free scheduled prenatal care visits and include routine screening and treatment for asymptomatic bacteriuria. Therefore, in the study we found that the UTIs prevalence rates among Taiwanese pregnancy women were much lower (8.6%) than among westerners (24.2–16.6%) (2). Furthermore, the incidence of antepartum pyelonephritis was only 0.34%, which is less than that reported in the 1970s (3–4%) before the universal screening for asymptomatic bacteriuria was used.…”

Section: Discussionmentioning

confidence: 93%

“…Therefore pregnancy is considered a risk factor for UTI. The incidence can be as high as 17% in pregnant women in the United States (2).…”

Section: Introductionmentioning

confidence: 99%

No increased risk of adverse pregnancy outcomes in women with urinary tract infections: a nationwide population‐based study

Chen

et al. 2010

Acta Obstet Gynecol Scand

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“…Several researchers have called for the development of a national surveillance system so that complications can be better ascertained, monitored, and studied. 5,[32][33][34][35] However, the lack of clear definitions and consistent methods hinders attempts to conduct national surveillance. A practical alternative may be to establish a system of monitoring selected priority morbidities, and factors associated with them, in defined populations, such as multiple managed care organizations [36][37][38] .…”

Section: Discussionmentioning

confidence: 99%

Extent of Maternal Morbidity in a Managed Care Population in Georgia

Bruce¹,

Berg²,

Joski

et al. 2012

Paediatric Perinatal Epid

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SummaryAlthough maternal deaths are among the most tragic events related to pregnancy, they are uncommon in the United States and therefore, inadequate indicators of a woman's pregnancyrelated health. Maternal morbidity has become a more useful measure for surveillance and research. Traditional attempts to monitor maternal morbidity have used hospital discharge data, which include data only on complications that resulted in hospitalization, thus underestimating the frequency and scope of complications. To obtain a more accurate assessment of morbidity, we applied a validated computerized algorithm to identify pregnancies and pregnancy-related complications in a defined population of women enrolled in a health maintenance organization in the southeastern United States. We examined the most common morbidities by pregnancy outcome and maternal characteristics.We identified 37,741 pregnancies; in half (50.7%), at least 1 complication occurred. The 5 most common were urinary tract infections, anemia, mental health conditions, pelvic and perineal complications, and obstetric infection. We observed that in pregnancies among non-Hispanic White women, low socioeconomic status (SES) had a modest effect on the adjusted odds of preexisting medical conditions [adjusted odd ratio (AOR) 1.33, 95% confidence interval (CI) 1.21, 1.47] or having any morbidity [AOR 1.27, 95% CI 1.16, 1.38]. Low SES had little effect on complications among non-Hispanic Black women. Compared with pregnancies among nonHispanic White women, those among non-Hispanic Black women had more complications and occurred more often in women with low SES; however, SES did not affect their likelihood of morbidity. Even for non-Hispanic White women, the effect of SES was small, suggesting that the influence of SES on the risk of morbidity may be ameliorated by comprehensive health insurance coverage.

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Racial, Ethnic, and Economic Disparities in the Prevalence of Pregnancy Complications

Abstract: Pregnancy complications are common and not adequately measured by hospitalizations alone. Both more research and improved surveillance are needed to understand the effect of pregnancy complications on women's health and the reasons for the increased risk among poor or black women.

Cited by 26 publications

References 26 publications

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings

No increased risk of adverse pregnancy outcomes in women with urinary tract infections: a nationwide population‐based study

Extent of Maternal Morbidity in a Managed Care Population in Georgia

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