(1102) Racial disparities in a comorbidity-based screening tool to predict severe maternal morbidity

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Recent data have suggested that a comorbidity-based screening tool can identify patients at risk of severe maternal morbidity (SMM). We aimed to determine whether this screening tool’s ability to predict SMM is impacted by maternal race/ethnicity.

Study Design: Retrospective cohort study of all patients who delivered (gestational age > 20 weeks) in 7 obstetrical units within an integrated health system from 1/1/19 to 12/31/21. Cases were stratified into 6 groups based on maternal race/ethnicity: non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic (H), Asian or Pacific Islander (A/PI), other/multiracial (O), and declined/unknown. Each patient was assigned an obstetric comorbidity index (OB-CMI) score based on clinical diagnosis codes. The primary outcome of SMM was derived from the Centers for Disease Control and Prevention list of 21 indicators. Multiple logistic regressions were performed to evaluate the association between OB-CMI and SMM within each race/ethnicity group, while adjusting for potential confounders.

Results: A total of 73,318 patients were included. The prevalence of SMM within each race/ethnicity group is displayed in Table 1. In stratifying the logistic regression model by race, a 1-point increase in OB-CMI score was significantly associated with higher adjusted odds of SMM across all race/ethnicity groups (Table 2). The increase in odds of SMM associated with OB-CMI was significantly higher in NHW and A/PI compared to H, and similar in NHW compared to NHB (Table 2). Receiver operator curves demonstrated the following areas under the curve for each race/ethnicity group: NHW (0.71), NHB (0.72), H (0.65), A/PI (0.69), and O (0.70).

Conclusion: The association between OB-CMI and SMM is impacted by maternal race/ethnicity. While increased OB-CMI was associated with an increased odds of SMM within each maternal race/ethnicity group, the odds of SMM was significantly higher in NHW and A/PI compared to H. Further research is needed to elucidate the underlying reasons for these disparities.

Primary & Presenting Author(s)

Moti Gulersen, MD,MSc
Assistant Professor, Obstetrics and Gynecology
Sidney Kimmel Medical College at Thomas Jefferson University
Philadelphia, Pennsylvania, United States

Coauthor(s)

AA
Alejandro D. Alvarez, MPH
Feinstein Institutes for Medical Research
Manhasset, New York, United States
FS
Fernando Suarez, N/A
Northwell Health
Manhasset, New York, United States
Insaf Kouba, MD (she/her/hers)
Fellow, Division of Maternal-Fetal Medicine
Zucker School of Medicine at Hofstra and Northwell
Manhasset, New York, United States
BR
Burton Rochelson, MD
Chief, Maternal-Fetal Medicine
Zucker School of Medicine at Hofstra and Northwell
Manhasset, New York, United States
AC
Adriann Combs, MSN, RN
Northwell Health
Manhasset, New York, United States
MN
Michael Nimaroff, MBA, MD
Senior Vice President Executive Director Ob/Gyn - Northwell Health; Chairman Department of Ob/Gyn
Zucker School of Medicine at Hofstra and Northwell
Manhasset, New York, United States
MB
Matthew J. Blitz, MD
Zucker School of Medicine at Hofstra and Northwell
Manhasset, New York, United States