TABLE 2.
Multiply Adjusted Associations Between Individual Covariates and Severe Maternal Mortality With and Without Blood Transfusion During Delivery Hospitalization by Race and Ethnicity, Georgia, 2009–2020
| Delivery hospitalization SMM | Delivery hospitalization SMM, excluding blood transfusion | |||||||
|---|---|---|---|---|---|---|---|---|
| Non-Hispanic White | Non-Hispanic Black | Non-Hispanic White | Non-Hispanic Black | |||||
| Characteristic | SMM Rate* | Adjusted RR | SMM Rate* | Adjusted RR | SMM Rate* | Adjusted RR | SMM Rate* | Adjusted RR |
| Race-specific rate | 133.5 | — | 234.7 | — | 57.3 | — | 89.6 | — |
| Maternal age | ||||||||
| <17 | 250.5 | 1.3 (1.0, 1.7) | 257.0 | 1.2 (1.0, 1.4) | 87.7 | 1.2 (0.7, 1.8) | 74.1 | 0.8 (0.5, 1.1) |
| 17–19 | 166.0 | 1.0 (0.9, 1.2) | 238.4 | 1.1 (1.0, 1.2) | 51.0 | 0.8 (0.6, 0.9) | 89.7 | 1.0 (0.9, 1.2) |
| 20–24 | 136.5 | 1.0 (0.9, 1.1) | 214.1 | 1.0 (0.9, 1.1) | 50.7 | 0.9 (0.8, 1.0) | 74.1 | 1.0 (0.9, 1.1) |
| 25–29 | 120.8 | Ref | 213.7 | Ref | 53.2 | Ref | 74.9 | Ref |
| 30–34 | 121.8 | 1.1 (1.0, 1.1) | 238.5 | 1.1 (1.0, 1.2) | 55.8 | 1.1 (1.0, 1.2) | 98.9 | 1.3 (1.2, 1.5) |
| 35–39 | 147.1 | 1.3 (1.2, 1.4) | 301.0 | 1.3 (1.2, 1.4) | 71.6 | 1.4 (1.3, 1.6) | 134.3 | 1.7 (1.5, 1.9) |
| >=40 | 218.1 | 1.8 (1.6, 2.1) | 397.6 | 1.6 (1.4, 1.8) | 115.4 | 2.3 (1.9, 2.8) | 199.8 | 2.3 (1.9, 2.8) |
| Marital status | ||||||||
| Married | 124.2 | Ref | 215.4 | Ref | 55.8 | Ref | 95.2 | Ref |
| Unmarried | 156.1 | 1.0 (1.0, 1.1) | 240.4 | 1.1 (1, 1.2) | 60.9 | 1.0 (0.9, 1.1) | 87.0 | 1.0 (0.9, 1.1) |
| Insurance payor | ||||||||
| Private | 120.9 | Ref | 203.3 | Ref | 55.2 | Ref | 86.8 | Ref |
| Medicaid | 155.8 | 1.2 (1.1, 1.3) | 242.6 | 1.1 (1.1, 1.2) | 60.1 | 1.1 (0.9, 1.2) | 85.8 | 1.1 (1.0, 1.2) |
| Medicare | 156.6 | 1.2 (1.0, 1.4) | 409.7 | 1.7 (1.5, 2.0) | 80.8 | 1.4 (1.0, 1.7) | 227.4 | 2.4 (1.9, 2.9) |
| Self pay | 152.2 | 1.1 (0.8, 1.4) | 343.1 | 1.4 (1.2, 1.7) | 38.9 | 0.6 (0.4, 1.0) | 139.4 | 1.5 (1.1, 1.8) |
| Other payors | 117.8 | 1.0 (0.9, 1.1) | 200.7 | 1.0 (0.9, 1.1) | 59.1 | 1.1 (0.9, 1.2) | 95.1 | 1.2 (1.0, 1.4) |
| Education | ||||||||
| Less than high school | 166.3 | 1.3 (1.0, 1.6) | 272.4 | 1.2 (1.0, 1.5) | 61.4 | 1.2 (0.8, 1.8) | 91.6 | 1.1 (0.8, 1.6) |
| Some high school | 183.1 | 1.4 (1.2, 1.5) | 268.6 | 1.2 (1.1, 1.3) | 62.0 | 1.2 (1.0, 1.4) | 90.8 | 1.1 (1.0, 1.3) |
| High school degree/GED | 143.9 | 1.1 (1.1, 1.2) | 248.3 | 1.2 (1.1, 1.2) | 60.1 | 1.1 (1.0, 1.3) | 91.1 | 1.2 (1.1, 1.3) |
| Some college or higher | 120.1 | Ref | 209.0 | Ref | 54.4 | Ref | 84.8 | Ref |
| Tobacco use during pregnancy | ||||||||
| No | 132.1 | Ref | 232.0 | Ref | 56.8 | Ref | 88.8 | Ref |
| Yes | 143.1 | 0.9 (0.8, 1.0) | 278.3 | 1.0 (0.9, 1.1) | 60.2 | 1.0 (0.9, 1.2) | 94.3 | 0.9 (0.7, 1.1) |
| NCHS rural-urban | ||||||||
| Large central metro | 117.3 | Ref | 288.1 | Ref | 43.0 | Ref | 96.7 | Ref |
| Large fringe metro | 134.3 | 1.1 (1.0, 1.3) | 235.7 | 0.9 (0.8, 0.9) | 55.0 | 1.4 (1.2, 1.7) | 88.1 | 0.9 (0.8, 1.0) |
| Medium metro | 101.8 | 0.8 (0.7, 0.9) | 169.7 | 0.6 (0.5, 0.6) | 59.6 | 1.4 (1.1, 1.8) | 79.3 | 0.9 (0.7, 1.0) |
| Small metro | 119.7 | 1.0 (0.9, 1.1) | 212.5 | 0.7 (0.7, 0.8) | 51.1 | 1.3 (1.0, 1.6) | 88.9 | 0.9 (0.8, 1.1) |
| Micropolitan | 165.4 | 1.3 (1.2, 1.5) | 259.8 | 0.9 (0.8, 0.9) | 72.5 | 1.8 (1.5, 2.3) | 94.8 | 1.0 (0.9, 1.2) |
| Noncore | 160.2 | 1.3 (1.1, 1.5) | 258.9 | 0.9 (0.8, 1.0) | 66.2 | 1.7 (1.4, 2.2) | 99.3 | 1.1 (0.9, 1.3) |
| Plurality | ||||||||
| Single | 127.4 | Ref | 224.2 | Ref | 55.5 | Ref | 87.1 | Ref |
| Multiple | 465.5 | 3.5 (3.1, 3.8) | 738.3 | 3 (2.7, 3.3) | 160.0 | 2.6 (2.1, 3.0) | 207.1 | 2.0 (1.7, 2.4) |
| Parity | ||||||||
| nulliparity | 149.4 | Ref | 222.9 | Ref | 62.1 | Ref | 97.5 | Ref |
| low multiparity (1–3) | 117.2 | 0.8 (0.7, 0.8) | 225.3 | 1.0 (1.0, 1.1) | 51.9 | 0.8 (0.7, 0.8) | 79.7 | 0.7 (0.7, 0.8) |
| grand multipara (4+) | 206.1 | 1.0 (0.9, 1.2) | 364.0 | 1.3 (1.2, 1.4) | 88.6 | 1.0 (0.8, 1.2) | 120.2 | 0.9 (0.7, 1.0) |
| Prenatal care | ||||||||
| Prenatal Care | 129.4 | Ref | 217.5 | Ref | 54.8 | Ref | 80.6 | Ref |
| Late or no prenatal care | 149.3 | 1.1 (0.9, 1.2) | 269.4 | 1.1 (1.1, 1.2) | 57.0 | 1.0 (0.8, 1.3) | 90.8 | 1.1 (1.0, 1.3) |
| Pre-pregnancy hypertension | ||||||||
| No | 132.1 | Ref | 227.1 | Ref | 56.3 | Ref | 84.3 | Ref |
| Yes | 214.5 | 1.5 (1.3, 1.8) | 461.4 | 1.9 (1.8, 2.1) | 113.3 | 1.8 (1.4, 2.3) | 244.6 | 2.7 (2.3, 3.1) |
| Gestational hypertension | ||||||||
| No | 121.5 | Ref | 210.8 | Ref | 50.4 | Ref | 75.2 | Ref |
| Yes | 322.4 | 2.4 (2.2, 2.6) | 578.9 | 2.6 (2.5, 2.8) | 164.8 | 3.0 (2.7, 3.3) | 293.9 | 3.7 (3.3, 4) |
| Gestational diabetes | ||||||||
| No | 132.0 | Ref | 232.2 | Ref | 56.4 | Ref | 88.1 | Ref |
| Yes | 165.0 | 1.0 (0.9, 1.2) | 281.3 | 1.0 (0.9, 1.1) | 75.1 | 1.0 (0.8, 1.2) | 114.6 | 0.9 (0.8, 1.1) |
*
SMM rates are events per 10,000 deliveries.
SMM indicates severe maternal morbidity.