scholarly journals Racial/ethnic disparities in sleep in mothers and infants during the Covid-19 pandemic

2021 ◽  
Author(s):  
Maristella Lucchini ◽  
Margaret Kyle ◽  
Nicolò Pini ◽  
Ayesha Sania ◽  
Vanessa Babineau ◽  
...  
Keyword(s):  
Mental Health ◽  
Maternal Mental Health ◽  
Post Partum ◽  
Ethnic Disparities ◽  
Infant Sleep ◽  
Maternal Sleep ◽  
Hispanic Mothers ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

ABSTRACTStudy ObjectivesTo quantify the association between race/ethnicity and maternal and infant self-reported sleep health at 4 months, exploring the role of maternal depression, stress and symptoms of trauma related to the COVID-19 pandemic as potential mediators.MethodsParticipants were recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) cohort at Columbia University (N=71 non-Hispanic White, N=14 African American (AA), N=113 Hispanic, N=40 other/declined). Data on infant sleep were collected at 4 months postpartum. A subset of 149 women also completed questionnaires assessing maternal mental health and sleep. Multivariable regressions were used to separately estimate associations of race/ethnicity and mental health with multiple sleep domains for infants and mothers adjusting for individual-level covariates.ResultsCompared to non-Hispanic White, Hispanic infants slept less at night (β=- 101.7±17.6, p<0.0001) and AA and Hispanic infants went to bed later (respectively β =1.9±0.6, p<0.0001, β=1.7±0.3, p<0.0001). Hispanic mothers were less likely to perceive infant sleep as a problem (β=1.0±0.3, p=0.006). Compared to non-Hispanic White mothers, Hispanic mothers reported worse maternal sleep latency (β=1.2±0.4, p=0.002), and efficiency (β=0.8±0.4, p=0.03), but better subjective sleep quality (β=-0.7±0.4, p=0.05), and less daytime dysfunction (β=-0.8±0.4, p=0.04). Maternal mental health scores were statistically significant predictors of multiple domains of maternal sleep but did not mediate the association between race/ethnicity and sleep.ConclusionsRacial/ethnic disparities in maternal and infant sleep are observable at 4 months post-partum. Maternal stress, depression and symptoms of trauma related to the COVID-19 pandemic did not mediate these associations.

Trends in breast cancer survival by race-ethnicity in Florida.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18556-e18556
Author(s):  
Robert Brooks Hines ◽  
Asal Johnson ◽  
Eunkyung Lee ◽  
Stephanie Erickson ◽  
Saleh M.M. Rahman
Keyword(s):  
Breast Cancer ◽  
Ethnic Disparities ◽  
Cancer Death ◽  
Cancer Outcomes ◽  
Subdistribution Hazard ◽  
Breast Cancer Death ◽  
Breast Cancer Outcomes ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

e18556 Background: Considerable efforts to improve disparities in breast cancer outcomes for underserved women have occurred over the past 3 decades. This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period to assess potential improvement in racial-ethnic disparities. Methods: This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990-2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no) as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic white (HW), and Hispanic black (HB). Cumulative incidence estimates of 5- and 10-year breast cancer death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution hazard ratios (sHR) for the relative rate of breast cancer death accounting for competing causes. Results: Compared to NHW women, minority women were more likely to be younger, be uninsured or have Medicaid as health insurance, live in high poverty neighborhoods, have more advanced disease at diagnosis, have high grade tumors, have hormone receptor negative tumors, and receive chemotherapy as treatment. Minority women were less likely to receive surgery. Over the course of the study, breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement in breast cancer survival for nearly all metrics compared to non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women having twice the rate of 5-year (sHR = 2.04: 95% CI; 1.91-2.19) and 10-year (sHR = 2.02: 95% CI; 1.89-2.16) breast cancer death. Conclusions: Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, additional targeted approaches are needed to reduce the poorer survival in black (especially NHB) women. Our next step is to conduct a mediation analysis of the most important factors driving racial/ethnic disparities in breast cancer outcomes for women in Florida.

scholarly journals County‐Level Factors Associated With Cardiovascular Mortality by Race/Ethnicity

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Bongeka Z. Zuma ◽  
Justin T. Parizo ◽  
Areli Valencia ◽  
Gabriela Spencer‐Bonilla ◽  
Manuel R. Blum ◽  
...  
Keyword(s):  
Risk Factors ◽  
Healthcare Access ◽  
Ethnic Disparities ◽  
County Level ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White ◽  
Cvd Mortality

Background Persistent racial/ethnic disparities in cardiovascular disease (CVD) mortality are partially explained by healthcare access and socioeconomic, demographic, and behavioral factors. Little is known about the association between race/ethnicity‐specific CVD mortality and county‐level factors. Methods and Results Using 2017 county‐level data, we studied the association between race/ethnicity‐specific CVD age‐adjusted mortality rate (AAMR) and county‐level factors (demographics, census region, socioeconomics, CVD risk factors, and healthcare access). Univariate and multivariable linear regressions were used to estimate the association between these factors; R 2 values were used to assess the factors that accounted for the greatest variation in CVD AAMR by race/ethnicity (non‐Hispanic White, non‐Hispanic Black, and Hispanic/Latinx individuals). There were 659 740 CVD deaths among non‐Hispanic White individuals in 2698 counties; 100 475 deaths among non‐Hispanic Black individuals in 717 counties; and 49 493 deaths among Hispanic/Latinx individuals across 267 counties. Non‐Hispanic Black individuals had the highest mean CVD AAMR (320.04 deaths per 100 000 individuals), whereas Hispanic/Latinx individuals had the lowest (168.42 deaths per 100 000 individuals). The highest CVD AAMRs across all racial/ethnic groups were observed in the South. In unadjusted analyses, the greatest variation ( R 2 ) in CVD AAMR was explained by physical inactivity for non‐Hispanic White individuals (32.3%), median household income for non‐Hispanic Black individuals (24.7%), and population size for Hispanic/Latinx individuals (28.4%). In multivariable regressions using county‐level factor categories, the greatest variation in CVD AAMR was explained by CVD risk factors for non‐Hispanic White individuals (35.3%), socioeconomic factors for non‐Hispanic Black (25.8%), and demographic factors for Hispanic/Latinx individuals (34.9%). Conclusions The associations between race/ethnicity‐specific age‐adjusted CVD mortality and county‐level factors differ significantly. Interventions to reduce disparities may benefit from being designed accordingly.

scholarly journals Race/ethnicity in systemic AL amyloidosis: perspectives on disease and outcome disparities

2020 ◽  
Vol 10 (11) ◽  
Author(s):  
Andrew Staron ◽  
Lawreen H. Connors ◽  
Luke Zheng ◽  
Gheorghe Doros ◽  
Vaishali Sanchorawala
Keyword(s):  
Minority Groups ◽  
Ethnic Disparities ◽  
Sociodemographic Factors ◽  
Al Amyloidosis ◽  
Advocacy Groups ◽  
Disease Characteristics ◽  
Race Ethnicity ◽  
The Impact ◽  
Racial Ethnic ◽  
Hispanic White

Abstract In marked contrast to multiple myeloma, racial/ethnic minorities are underrepresented in publications of systemic light-chain (AL) amyloidosis. The impact of race/ethnicity is therefore lacking in the narrative of this disease. To address this gap, we compared disease characteristics, treatments, and outcomes across racial/ethnic groups in a referred cohort of patients with AL amyloidosis from 1990 to 2020. Among 2416 patients, 14% were minorities. Non-Hispanic Blacks (NHBs) comprised 8% and had higher-risk sociodemographic factors. Hispanics comprised 4% and presented with disproportionately more BU stage IIIb cardiac involvement (27% vs. 4–17%). At onset, minority groups were younger in age by 4–6 years. There was indication of more aggressive disease phenotype among NHBs with higher prevalence of difference between involved and uninvolved free light chains >180 mg/L (39% vs. 22–33%, P = 0.044). Receipt of stem cell transplantation was 30% lower in Hispanics compared to non-Hispanic White (NHWs) on account of sociodemographic and physiologic factors. Although the age/sex-adjusted hazard for death among NHBs was 24% higher relative to NHWs (P = 0.020), race/ethnicity itself did not impact survival after controlling for disease severity and treatment variables. These findings highlight the complexities of racial/ethnic disparities in AL amyloidosis. Directed efforts by providers and advocacy groups are needed to expand access to testing and effective treatments within underprivileged communities.

scholarly journals Racial/Ethnic Disparities in Dietary Intake of U.S. Children Participating in WIC

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2607 ◽  
Author(s):  
Meghan C. Zimmer ◽  
Veronica Rubio ◽  
Kristina W. Kintziger ◽  
Cristina Barroso
Keyword(s):  
Low Income ◽  
Nutrient Intake ◽  
Ethnic Disparities ◽  
Black Children ◽  
Hispanic Children ◽  
White Children ◽  
Food Package ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

Recent studies have assessed diet quality of low-income U.S. children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but differences by race/ethnicity remain unknown. We assessed racial/ethnic disparities in nutrient intake from dietary sources (not supplements) among children participating in WIC, with a focus on priority nutrients and food groups for future WIC food package revisions, as described in a recent report by the National Academies of Sciences, Engineering, and Medicine (NASEM). We used data from the 2011–2014 National Health and Nutrition Examination Surveys (NHANES) and multivariable linear regression analysis to evaluate relationships between race/ethnicity and nutrient/food group intake of children participating in WIC. All data were analyzed using SAS 9.4 survey procedures, accounting for the complex survey design of the NHANES. Compared to non-Hispanic White children, Hispanic children had diets with better nutrient distribution and lower dietary energy density, while non-Hispanic Black children had diets with poorer nutrient intake. Hispanic children had higher potassium and fiber intake, and consumed more legumes, while non-Hispanic Black children had lower calcium and vitamin D intake, higher sodium intake, and lower total dairy intake, compared to non-Hispanic White children. These findings can inform WIC nutrition education messages and future food package revisions.

scholarly journals Racial and Ethnic Disparities in Heart and Cerebrovascular Disease Deaths During the COVID-19 Pandemic in the United States

Circulation ◽  
2021 ◽  
Author(s):  
Rishi Wadhera ◽  
Jose F. Figueroa ◽  
Fatima Rodriguez ◽  
Michael Liu ◽  
Wei Tian ◽  
...  
Keyword(s):  
United States ◽  
Heart Disease ◽  
Cerebrovascular Disease ◽  
Ethnic Minorities ◽  
Minority Group ◽  
Ethnic Disparities ◽  
The United States ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

Background: Cardiovascular deaths increased during the early phase of the COVID-19 pandemic in the United States. However, it is unclear whether racial/ethnic minorities have experienced a disproportionate rise in heart disease and cerebrovascular disease deaths. Methods: We used the National Center for Health Statistics to identify heart disease and cerebrovascular disease deaths for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals from March-August 2020 (pandemic period), as well as for the corresponding months in 2019 (historical control). We determined the age- and sex-standardized deaths per million by race/ethnicity for each year. We then fit a modified Poisson model with robust standard errors to compare change in deaths by race/ethnicity for each condition in 2020 vs. 2019. Results: There were a total of 339,076 heart disease and 76,767 cerebrovascular disease deaths from March through August 2020, compared to 321,218 and 72,190 deaths during the same months in 2019. Heart disease deaths increased during the pandemic in 2020, compared with the corresponding period in 2019, for non-Hispanic White (age-sex standardized deaths per million, 1234.2 vs. 1208.7; risk ratio for death [RR] 1.02, 95% CI 1.02-1.03), non-Hispanic Black (1783.7 vs. 1503.8; RR 1.19, 1.17-1.20), non-Hispanic Asian (685.7 vs. 577.4; RR 1.19, 1.15-1.22), and Hispanic (968.5 vs. 820.4, RR 1.18, 1.16-1.20) populations. Cerebrovascular disease deaths also increased for non-Hispanic White (268.7 vs. 258.2; RR 1.04, 95% CI 1.03-1.05), non-Hispanic Black (430.7 vs. 379.7; RR 1.13, 95% CI 1.10-1.17), non-Hispanic Asian (236.5 vs. 207.4; RR 1.15, 1.09-1.21), and Hispanic (264.4 vs. 235.9; RR 1.12, 1.08-1.16) populations. For both heart disease and cerebrovascular disease deaths, each racial and ethnic minority group experienced a larger relative increase in deaths than the non-Hispanic White population (interaction term, p<0.001). Conclusions: During the COVID-19 pandemic in the US, Black, Hispanic, and Asian populations experienced a disproportionate rise in deaths due to heart disease and cerebrovascular disease, suggesting that racial/ethnic minorities have been most impacted by the indirect effects of the pandemic. Public health and policy strategies are needed to mitigate the short- and long-term adverse effects of the pandemic on the cardiovascular health of minority populations.

scholarly journals Racial and ethnic disparities in maternal mental health during COVID-19

2021 ◽  
Author(s):  
Ananya Suresh Iyengar ◽  
Tsachi Ein-Dor ◽  
Emily Xujia Zhang ◽  
Sabrina Josephine Chan ◽  
Anjali Joann Kaimal ◽  
...  
Keyword(s):  
Mental Health ◽  
Traumatic Stress ◽  
Maternal Mental Health ◽  
Minority Group ◽  
Ethnic Disparities ◽  
Racial And Ethnic Disparities ◽  
Black African ◽  
Clinically Significant ◽  
Skin To Skin ◽  
Hispanic White

Knowledge of childbirth outcomes of Black and Latinx individuals during the coronavirus pandemic is limited. Black/African American and Latinx/Hispanic individuals were matched to non-Hispanic white individuals on socio-demographics. Minority individuals were nearly three times more likely to have clinically significant traumatic stress in response to childbirth and two times more likely to report postpartum depression. Unplanned Cesarean rates were higher and incidences of skin-to-skin and breastfeeding were lower in the minority group. Racial and ethnic maternal disparities exist during COVID-19.

scholarly journals Racial/Ethnic Variability in Hypertension Prevalence and Risk Factors in National Health Interview Survey

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
L. Holmes ◽  
J. Hossain ◽  
D. Ward ◽  
F. Opara
Keyword(s):  
Risk Factors ◽  
National Health ◽  
National Health Interview Survey ◽  
Ethnic Disparities ◽  
Health Interview Survey ◽  
Ethnic Variability ◽  
Interview Survey ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

Objective. Hypertension is one of the leading causes of death attributed to cardiovascular diseases, and the prevalence varies across racial/ethnic groups, with African Americans being disproportionately affected. The underlying causes of these disparities are not fully understood despite volume of literature in this perspective. We aimed in this current study to examine ethnic/racial disparities in hypertension utilizing Hispanics as the base racial/ethnic group for comparison. Research Design and Methods. We utilized the National Health Interview Survey (NHIS), which is a large cross-sectional survey of the United States non-institutionalized residents to investigate the racial/ethnic disparities in hypertension after the adjustment of other socio-economic, demographic, and prognostic risk factors. The study participants were adults (n = 30,852). Data were analyzed using Chi square statistic, and logistic regression model. Results. There were statistically significant differences by race/ethnicity with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, P < 0.01, but not insurance coverage, P > 0.01. Hispanic ethnicity (18.9%) compared to either non-Hispanic white (27.7%) or non-Hispanic black (35.5%) was associated with the lowest prevalence of hypertension. Race/ethnicity was a single independent predictor of hypertension, with non-Hispanic black more likely to be hypertensive compare with Hispanic, prevalence odds ratio (POR), 2.38, 99% Confidence Interval (CI), 2.17–2.61 and non-Hispanic white, POR, 1.64, 99% CI, 1.52–1.77. After controlling for the confounding variables, the racial/ethnic differences in hypertension persisted. Conclusions. Racial/ethnic disparities in hypertension persisted after controlling for potential predictors of hypertension in NHIS, implying the inability of known hypertension risk factors to account for racial/ethnic variability in hypertension in US.

scholarly journals Recent trends in US mortality in early and middle adulthood: racial/ethnic disparities in inter-cohort patterns

2018 ◽  
Vol 48 (3) ◽  
pp. 934-944 ◽  
Author(s):  
Emma Zang ◽  
Hui Zheng ◽  
Yang Claire Yang ◽  
Kenneth C Land
Keyword(s):  
Baby Boomers ◽  
Ethnic Disparities ◽  
Mortality Data ◽  
Mortality Trends ◽  
Mortality Pattern ◽  
Drug Poisoning ◽  
Gender And Race ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

Abstract Background A striking increase in the all-cause mortality of US middle-aged non-Hispanic Whites in the past two decades has been documented by previous studies. The inter-cohort patterns in US mortality, as well as their racial/ethnic disparities, are still unclear. Methods Using official mortality data, we study US annual mortality rates for ages 25–54 from 1990 to 2016 by gender and race/ethnicity. We conduct an age-period-cohort analysis to disentangle the period and cohort forces driving the absolute changes in mortality across cohorts. Nine leading causes of death are also explored to explain the inter-cohort mortality patterns and their racial/ethnic disparities. Results We find cohort-specific elevated mortality trends for gender- and race/ethnicity-specific populations. For non-Hispanic Blacks and Hispanics, Baby Boomers have increased mortality trends compared with other cohorts. For non-Hispanic White females, it is late-Gen Xers and early-Gen Yers for whom the mortality trends are higher than other cohorts. For non-Hispanic White males, the elevated mortality pattern is found for Baby Boomers, late-Gen Xers, and early-Gen Yers. The mortality pattern among Baby Boomers is at least partially driven by mortality related to drug poisoning, suicide, external causes, chronic obstructive pulmonary disease and HIV/AIDS for all race and gender groups affected. The elevated mortality patterns among late-Gen Xers and early-Gen Yers are at least partially driven by mortality related to drug poisonings and alcohol-related diseases for non-Hispanic Whites. Differential patterns of drug poisoning-related mortality play an important role in the racial/ethnic disparities in these mortality patterns. Conclusions We find substantial racial/ethnic disparities in inter-cohort mortality patterns. Our findings also point to the unique challenges faced by younger generations.

scholarly journals Racial and Ethnic Disparities in Systemic AL Amyloidosis: Examining Differences in Clinical Presentation and Outcomes

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 51-51
Author(s):  
Andrew Staron ◽  
Lawreen H Connors ◽  
Luke Zheng ◽  
Gheorghe Doros ◽  
Vaishali Sanchorawala
Keyword(s):  
Research Funding ◽  
Cardiac Involvement ◽  
Clinical Presentation ◽  
Ethnic Disparities ◽  
Sociodemographic Factors ◽  
Advisory Board ◽  
Al Amyloidosis ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

Background: Racial/ethnic minorities have been underrepresented in most population-based studies of AL amyloidosis published to date. This observation stands in marked contrast to multiple myeloma, a closely related disorder with a twofold higher incidence among blacks vs. whites. Given the scarcity of information about health disparities in AL amyloidosis, we aimed to characterize the clinical presentation and outcomes of this unique plasma cell disorder according to race/ethnicity. Methods: Data on consented patients with systemic AL amyloidosis seen at the Boston University Amyloidosis Center between 1990 and 2020 were obtained from a prospectively maintained database (ClinicalTrials.gov Identifier: NCT00898235). Sociodemographic factors, hematologic and organ disease markers, along with the use of high-dose melphalan and stem cell transplantation (HDM/SCT) were stratified by self-reported race/ethnicity. Groups included non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and non-Hispanic other (NHO). Differences were assessed by χ2 test for categorical variables and one-way ANOVA test for continuous variables. Multivariable logistic regression was used to determine the influence of variables on HDM/SCT utilization. The effect of race/ethnicity on mortality was estimated by multivariate Cox proportional hazards regression with adjustment for relevant confounders. Results: In a cohort of 2,416 patients, only 14% were underrepresented minorities (Figure 1A). At diagnosis, racial/ethnic minority groups were younger than NHWs by a median of 4-6 years. NHBs comprised 8% of the cohort and had higher-risk sociodemographic factors (e.g. educational attainment of high school level or less among 39% vs. 25% for NHWs; P &lt; .001). Furthermore, there was an indication of more aggressive disease among NHBs with more patients having a difference between involved and uninvolved free light chains (dFLC) of &gt; 180 mg/L (39% vs. 22-33%; P = .044). Hispanics comprised 4% of the cohort and presented with more advanced cardiac disease (i.e. median BNP of 1,041 pg/mL vs. 221-480 pg/mL; P = .001). Among a subcohort of 1,668 patients with available treatment data, 33% of Hispanics and 39% of NHBs were treated with HDM/SCT as compared to 47% of NHWs (P = .071). This treatment disparity was accounted for by sociodemographic (i.e. lower educational level) and physiologic risk factors (i.e. stage III cardiac involvement), rather than race/ethnicity itself. At data cutoff in March 2020, 1,622 (67%) patients were deceased. Compared with NHWs, the median survival for NHBs was shorter by nearly one year (Figure 1B) with an age/sex-adjusted HR for death of 1.24 (95% CI 1.03-1.49; P = .020). After further adjusting for disease and treatment variables, this survival difference was eliminated altogether (HR 0.82; 95% CI 0.50-1.34; P = .427). Conclusions: For the first time, this study shines a spotlight on racial/ethnic disparities in AL amyloidosis. Systematic underdetection, along with delayed diagnosis and referral, may explain why minority patients bear a disproportionate burden of late-stage cardiac involvement and high dFLC at the time of initial presentation. In turn, these factors contribute to underutilization of effective treatments such as HDM/SCT (particularly among Hispanics) and poorer survival (among NHBs) as observed in our study. The possibility of predisposing genetic and/or biological factors will need to be considered in future studies. Ultimately, greater awareness of AL amyloidosis within underrepresented communities, together with more widespread and accessible testing, are necessary to mitigate these health disparities. Figure 1: (A) The distribution of race/ethnicity in a large cohort of patients with AL amyloidosis and (B) Kaplan-Meier survival curves are shown. NHW indicates non-Hispanic white; NHB, non-Hispanic black; and NHO, non-Hispanic other. Figure 1 Disclosures Sanchorawala: Caleum: Other: advisory board; Proclara: Other: advisory board; Abbvie: Other: advisory board; UpToDate: Patents & Royalties; Regeneron: Other: advisory board; Janssen: Research Funding; Takeda: Research Funding; Celgene: Research Funding; Prothena: Research Funding; Caelum: Research Funding; Oncopeptide: Research Funding.

Racial/Ethnic Disparities in Intensive Care Admissions in a Pregnant and Postpartum Population, Hawai‘i, 2012-2017

2021 ◽  
pp. 003335492110211
Author(s):  
Pamela Estrada ◽  
Hyeong Jun Ahn ◽  
Scott A. Harvey
Keyword(s):  
Maternal Morbidity ◽  
Clinical Characteristics ◽  
White Women ◽  
Ethnic Disparities ◽  
Severe Maternal Morbidity ◽  
Obstetric Outcomes ◽  
Icu Admission ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

Objective Maternal morbidity and mortality is a global concern despite advances in medical care and technology and improved economic resources of nations worldwide. The primary objective of our study was to describe racial/ethnic disparities in severe maternal morbidity by using admission to an intensive care unit (ICU) as a marker. The secondary objective was to evaluate associations between patient characteristics, including obstetric outcomes, and severe maternal morbidity. Methods This retrospective cohort study used a large inpatient database to identify pregnancy and postpartum hospitalizations in Hawai‘i from January 2012 through September 2017. We evaluated associations between sociodemographic and clinical characteristics and race/ethnicity by using χ2 tests. We used multivariable logistic regression to assess associations between race/ethnicity and ICU admission. We used a post hoc analysis to assess associations between ICU admission and obstetric outcomes by race/ethnicity. Results After adjustment, we found a significantly higher ICU admission rate among Asian (adjusted odds ratio [aOR] = 1.30; 95% CI, 1.04-1.62; P = .02), Filipino (aOR = 1.45; 95% CI, 1.17-1.79; P < .001), and Native Hawaiian/Other Pacific Islander (aOR = 1.39; 95% CI, 1.15-1.68; P < .001) women compared with non-Hispanic White women. Multiple clinical characteristics and outcomes were associated with ICU admission, such as preexisting chronic conditions and pregnancy-induced hypertensive disorders. Conclusion We found that severe maternal morbidity represented by ICU admission is higher among Asian, Filipino, and Native Hawaiian/Other Pacific Islander women than among non-Hispanic White women in Hawai’i. Our findings reemphasize the need for health care providers to be vigilant in caring for members of racial/ethnic minority groups and managing their comorbidities.

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