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. 2020 May;39(5):768-776.
doi: 10.1377/hlthaff.2019.00735.

Neighborhood Racial And Economic Polarization, Hospital Of Delivery, And Severe Maternal Morbidity

Teresa Janevic  1 , Jennifer Zeitlin  2 , Natalia Egorova  3 , Paul L Hebert  4 , Amy Balbierz  5 , Elizabeth A Howell  6
Affiliations

Neighborhood Racial And Economic Polarization, Hospital Of Delivery, And Severe Maternal Morbidity

Teresa Janevic et al. Health Aff (Millwood). 2020 May.

Abstract

Recent national and state legislation has called attention to stark racial/ethnic disparities in maternal mortality and severe maternal morbidity (SMM), the latter of which is defined as having a life-threatening condition or life-saving procedure during childbirth. Using linked New York City birth and hospitalization data for 2012-14, we examined whether racial and economic spatial polarization is associated with SMM rates, and whether the delivery hospital partially explains the association. Women in ZIP codes with the highest concentration of poor blacks relative to wealthy whites experienced 4.0 cases of SMM per 100 deliveries, compared with 1.7 cases per 100 deliveries among women in the neighborhoods with the lowest concentration (risk difference = 2.4 cases per 100). Thirty-five percent of this difference was attributable to the delivery hospital. Women in highly polarized neighborhoods were most likely to deliver in hospitals located in similarly polarized neighborhoods. Housing policy that targets racial and economic spatial polarization may address a root cause of SMM, while hospital quality improvement may mitigate the impact of such polarization.

Keywords: Diseases; Disparities in access; Disparities in quality; Health conditions; Health disparities; Health policy; Hospital quality; Housing; Low income; Maternal health; Mortality; Quality of care; Severe maternal morbidity.

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Figures

Exhibit 4
Exhibit 4
Percent of women who delivered in hospitals in racially and economically polarized neighborhoods in New York City in 2012–14, by polarization of the woman’s neighborhood SOURCE Authors’ analysis of New York City birth certificate and hospital discharge data linked to American Community Survey data. NOTES NOTES The Index of Concentration at the Extremes (ICE) measures for race, income, and race and income are explained in the notes to exhibit 1. Quintile 1 represents the highest relative concentration of non-Hispanic black, low-income, or non-Hispanic black and low-income households, and quintile 5 the lowest.
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