TABLE 2.
Prevalence and adjusted risk ratios of severe maternal morbidity (SMM) by HOLC score and maternal race and ethnicity; California, 1997–2017 (n = 2,020,194)
| Deliveries | SMM Cases | SMM Prevalence per 10,000 Deliveries | Model 1, RR (95% CI) | Model 2, RR (95% CI) | Model 3, RR (95% CI) | Model 4, RR (95% CI) | |
|---|---|---|---|---|---|---|---|
| Non-Hispanic Black (n = 229,606) | |||||||
| HOLC Grade A + B | 33,714 | 554 | 164 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| HOLC Grade C | 123,126 | 2105 | 171 | 1.06 (0.95, 1.18) | 1.07 (0.96, 1.20) | 1.05 (0.94, 1.17) | 1.05 (0.94, 1.17) |
| HOLC Grade D | 72,766 | 1345 | 185 | 1.15 (1.03, 1.29) | 1.17 (1.04, 1.31) | 1.13 (1.00, 1.26) | 1.12 (1.00, 1.26) |
|
| |||||||
| Hispanic (n = 1,447,676) | |||||||
| HOLC Grade A + B | 163,269 | 1700 | 104 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| HOLC Grade C | 775,681 | 8600 | 111 | 1.07 (1.00, 1.14) | 1.09 (1.02, 1.16) | 1.06 (1.00, 1.13) | 1.07 (1.00, 1.14) |
| HOLC Grade D | 508,726 | 6156 | 121 | 1.17 (1.09, 1.25) | 1.19 (1.11, 1.28) | 1.15 (1.08, 1.23) | 1.15 (1.08, 1.24) |
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| Non-Hispanic Asian/Pacific Islander (n = 337,167) | |||||||
| HOLC Grade A + B | 74,017 | 886 | 120 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| HOLC Grade C | 179,103 | 2146 | 120 | 1.07 (0.98, 1.16) | 1.08 (0.99, 1.17) | 1.05 (0.97, 1.15) | 1.04 (0.95, 1.14) |
| HOLC Grade D | 84,047 | 997 | 119 | 1.05 (0.95, 1.16) | 1.06 (0.96, 1.17) | 1.02 (0.93, 1.13) | 1.00 (0.90, 1.11) |
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| Non-Hispanic American Indian/Alaskan Native (n = 5745) | |||||||
| HOLC Grade A + B | NR | NR | 130 | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| HOLC Grade C | NR | NR | 176 | 1.70 (0.87, 3.35) | 1.80 (0.91, 3.57) | 1.71 (0.86, 3.40) | 1.51 (0.75, 3.07) |
| HOLC Grade D | NR | NR | 135 | 1.27 (0.59, 2.73) | 1.32 (0.61, 2.85) | 1.25 (0.57, 2.74) | 1.12 (0.50, 2.47) |
Note: Model 1: adjusted for maternal age, education, insurance type and nativity. Model 2: adjusted for covariates in Model 1 and parity, birth type. Model 3: adjusted for covariates in Model 2 and having any comorbidities. Model 4: adjusted for covariates in Models 1–3, as well as Neighbourhood Deprivation Index. Home Owner Loan Corporation (HOLC) Grade: A = best, B = still desirable, C = definitely declining, D = hazardous. NR, not reported; Sample sizes are not reported for some cells due to having fewer than 12 observations per data use in agreement with the state of California.