Los Angeles is home to many Hispanics and African Americans. According to a new study, these women are not receiving the same level of care as their Caucasian counterparts. Researchers affiliated with Mount Sinai School of Medicine in New York published their findings in the June issue of the journal Obstetrics and Gynecology.
The researchers note that more than four million births occur annually in the US, and childbirth is the largest category for hospital admissions for commercial payers and Medicaid programs. Complications associated with delivery are not rare and are related to quality of care at delivery. In addition3–6 Furthermore, persistent racial disparities in perinatal outcomes exist, with neonatal mortality rates in black women twice those in white women and maternal mortality rates in black women three to four times those in white women. They explain that hospital quality is associated with neonatal and obstetric outcomes and quality among hospitals varies. Preventable causes account for one third to one half of maternal deaths including hospital practices such as the management of hypertension (high blood pressure), deep venous thrombosis (DVT; blood clots), chronic diseases, and hemorrhage during delivery. Because of this situation, there is a rising focus on the quality of hospital care as a means to reduce both overall maternal and neonatal mortality and to narrow racial disparities in perinatal outcomes.
The Agency for Healthcare Research and Quality has developed seven indicators of obstetric healthcare quality and safety that make use of readily available hospital inpatient administrative data. The goals of the new study were to examine differences between black and white women in these indicators, explore geographic variation in these indicators by race, and examine differences between black and white women in maternal and neonatal mortality over time. They theorized that data over the past decade would demonstrate improving trends in quality and decreasing neonatal and maternal mortality for both black and white women.
The investigators reviewed the Nationwide Inpatient Sample from 2000 through 2009 and calculated obstetric hospital quality, patient safety indicators, and inpatient maternal and neonatal mortality stratified by race. They examined differences in age and comorbidity-adjusted trends (other health conditions present) in black compared with white women over time in the United States and by geographic region.
The study authors found that obstetric quality indicators varied by geographic region; however, changes over time were consistent for both races. Cesarean deliveries increased similarly for black and white women, and vaginal births after cesarean delivery declined for both races but more rapidly for white women than for black women. Obstetric safety indicators improved over the study period for black and white women, with obstetric trauma decreasing significantly for both groups (white: 28%; black: 35%) and birth trauma–injury to newborns declining for both; however, the changes were not statistically significant. In striking contrast, inpatient maternal and neonatal mortality remained relatively constant during the study period, with persistently higher rates of both seen among black compared with white women (black: 12.0 compared with 4.6 per 100,000 deliveries; white: 6.6 compared with 2.5 per 1,000 births) in 2009.
The study authors concluded that improvements in Agency for Healthcare Research and Quality indicators for obstetrics are not reflected in improvements in maternal and neonatal morbidity and mortality and do not explain continued racial disparities for outcomes in pregnancies in black and white women. They stressed that quality measures that are related to pregnancy outcomes are needed and these should elucidate obstetric health disparities.
Take home message:
Los Angeles is home to the Ronald Reagan UCLA Medical Center. Women who deliver there and receive care from a physician on their staff are guaranteed of receiving high-level care regardless of their ethnic background.