Table 4.
Adjusted odds ratios of the four individual adverse maternal outcomes associated with state-level indicators of structural racism (United States, 2017–2018)
| Black-to-white inequity ratio | Blood transfusion aOR (95% CI) (a) | ICU admission aOR (95% CI) (a) | Hysterectomy aOR (95% CI) (a) | Eclampsia aOR (95% CI) (a) |
|---|---|---|---|---|
|
| ||||
| Lower education level(less than high school diploma) | ||||
| Non-Hispanic white | 1.06 (0.96, 1.16) | 1.12 (1.03, 1.23) | 1.19 (1.05, 1.36) | 0.92 (0.79, 1.07) |
| Non-Hispanic Black | 1.07 (0.89, 1.30) | 1.08 (0.92, 1.28) | 1.25 (0.97, 1.61) | 0.84 (0.64, 1.01) |
| Unemployment rate | ||||
| Non-Hispanic white | 1.54 (1.30, 1.84) | 1.36 (1.15, 1.61) | 1.24 (0.97, 1.59) | 0.75 (0.57, 0.98) |
| Non-Hispanic Black | 2.07 (1.44, 2.97) | 1.51 (1.10, 2.06) | 1.61 (0.97, 2.67) | 0.68 (0.42, 1.10) |
| Prison incarceration rate | ||||
| Non-Hispanic white | 1.08 (1.05, 1.10) | 1.06 (1.03, 1.08) | 1.06 (1.03, 1.10) | 0.99 (0.95, 1.03) |
| Non-Hispanic Black | 1.10 (1.10, 1.10) | 1.05 (1.01, 1.09) | 1.11 (1.05, 1.17) | 0.97 (0.91, 1.03) |
Odds ratios are per 1-unit increase in the indicator. Indicators are non-Hispanic Black to non-Hispanic white inequity ratios in the three domains described above
aOR adjusted odds ratio, CI confidence interval, ICU intensive care unit
Odds ratios are estimated using mixed-effect logistic regression with the hospital county nested within the hospital state as the random effect, and adjusted for maternal age, health insurance, body mass index, residence (rural, suburban, urban), preexisting diabetes, preexisting hypertension, gestational hypertension, previous cesarean section, month prenatal care began, number of prenatal visits, mother transferred in, gestational age at delivery, multiple gestation, non-cephalic presentation, attendant at birth, delivery mode, birth weight, hospital location (rural, suburban, urban), and state Medicaid income eligibility threshold