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Racial Disparities in Parturients: Asian Women are at Increased Risk for In-Hospital Death
Abstract Number: O1-07
Abstract Type: Original Research
BACKGROUND: Racial disparities in maternal mortality have been described. Most previous studies have focused on African-American women with or without co-existing diseases. These studies have consistently demonstrated that African-American women are at a disproportionally increased risk for maternal mortality. However, it is not well defined if Asian parturients in the US are also at increased risk for mortality. The objective of this study was to determine if Asian parturients were at increased risk for in-hospital mortality compared to white women.
METHODS: In this IRB-exempt study, we obtained weighted estimates of the number of hospitalizations for deliveries in women aged 18-40 (ICD-9 codes) obtained through the National Inpatient Sample (NIS) from 2002 to 2013. NIS is a federal database, which contains discharge data from almost 5000 hospitals. The NIS samples 20% of discharges across all Health Care Utilization Project (HCUP) hospitals and is self-weighted to obtain accurate national estimates for all US hospital admissions. The results are reported as proportions with 95% confidence intervals.
RESULTS: There were 20,846,418 weighted deliveries by women ages 18-40 in the NIS during the study period. Asian women represented 8.9% of these patients. When compared with other racial groups, Asian parturients were more likely to be older, of a higher socioeconomic status, and have a lower Charlson comorbidity score. After adjusting for various factors, Asian parturients had a higher odds ratio of in-hospital death compared with white women (1.806, 95% CI 1.200-2.716).
CONCLUSION: Racial disparities in peripartum outcomes have been well described. Our analysis reveals that despite Asian women presenting with lower Charlson comorbidity scores, they are at increased risk for in-hospital death when compared to white women. This was true even after adjusting for age group, Charlson comorbidity scores, and payor mix. Physicians need to appreciate that Asian parturients have increased mortality despite having lower ‘traditional’ risk factors (e.g. higher socioeconomic status) than white women.
1. Creanga AA, Berg C, Syverson C, et al. Obstet Gynecol. 2012; 120:261-8.
2. Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/Ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol. 2010 Apr;202(4):335-43.