Neighborhood Deprivation and Severe Maternal Morbidity in a Medicaid Population

Few studies have examined whether neighborhood deprivation is associated with severe maternal morbidity (SMM) in already socioeconomically disadvantaged populations. Little is known about to what extent neighborhood deprivation accounts for Black–White disparities in SMM. This study investigated the...

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Bibliographic Details
Published in:American journal of preventive medicine 2024-05, Vol.66 (5), p.850-859
Main Authors: Yu, Xiao, Johnson, Jennifer E., Roman, Lee Anne, Key, Kent, McCoy White, Jonne, Bolder, Hannah, Raffo, Jennifer E., Meng, Ran, Nelson, Hannah, Meghea, Cristian I.
Format: Article
Language:English
Subjects:
Adult
Black or African American - statistics & numerical data
Female
Health Status Disparities
Humans
Maternal Health - statistics & numerical data
Medicaid
Michigan - epidemiology
Morbidity - trends
Neighborhood Characteristics - statistics & numerical data
Poverty - statistics & numerical data
Poverty Areas
Pregnancy
Socioeconomic Factors
United States - epidemiology
Vulnerable Populations - statistics & numerical data
White - statistics & numerical data
Young Adult
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Summary:Few studies have examined whether neighborhood deprivation is associated with severe maternal morbidity (SMM) in already socioeconomically disadvantaged populations. Little is known about to what extent neighborhood deprivation accounts for Black–White disparities in SMM. This study investigated these questions among a statewide Medicaid-insured population, a low-income population with heightened risk of SMM. Data were from Michigan statewide linked birth records and Medicaid claims between 01/01/2016 and 12/31/2019, and were analyzed between 2022 and 2023. Neighborhood deprivation was measured with the Area Deprivation Index at census block group and categorized as low, medium, or high deprivation. Multilevel logistic models were used to examine the association between neighborhood deprivation and SMM. Fairlie nonlinear decomposition was conducted to quantify the contribution of neighborhood deprivation to SMM racial disparity. People in the most deprived neighborhoods had higher odds of SMM than those in the least deprived neighborhoods (aOR [95% CI]: 1.27 [1.15, 1.40]). Such association was observed in Black (aOR [95% CI]: 1.34 [1.07, 1.67]) and White (aOR [95% CI]: 1.26 [1.12, 1.42]) racial subgroups. Decomposition showed that of 57.5 (cases per 10,000) explained disparity in SMM, neighborhood deprivation accounted for 23.1 (cases per 10,000; 95% CI: 16.3, 30.0) or two-fifths (40.2%) of the Black–White disparity. Analysis on SMM excluding blood transfusion showed consistent but weaker results. Neighborhood deprivation may be used as an effective tool to identify at-risk individuals within a low-income population. Community-engaged interventions aiming at improving neighborhood conditions may be helpful to reduce both SMM prevalence and racial inequity in SMM.
ISSN:0749-3797
1873-2607
1873-2607
DOI:10.1016/j.amepre.2023.11.016