Community-Level Factors are Predictors of Severe Maternal Morbidity Among American Indian and Alaska Native Pregnant People in the Pacific Northwest in a Multilevel Logistic Regression.

Publisher: Kluwer Academic/Plenum Publishers Country of Publication: United States NLM ID: 9715672 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1573-6628 (Electronic) Linking ISSN: 10927875 NLM ISO Abbreviation: Matern Child Health J Subsets: MEDLINE

Publication: 1999- : New York, NY : Kluwer Academic/Plenum Publishers
Original Publication: New York : Plenum Press, c1997-

American Indian or Alaska Native*/statistics & numerical data ; Social Determinants of Health*/ethnology ; Social Determinants of Health*/statistics & numerical data ; Residence Characteristics*/statistics & numerical data ; Pregnancy Complications*/epidemiology ; Pregnancy Complications*/ethnology ; Pregnancy Complications*/etiology ; Pregnancy Complications*/therapy; Female ; Humans ; Pregnancy ; Alaska Natives/statistics & numerical data ; Hypertension/epidemiology ; Hypertension/ethnology ; Indians, North American/statistics & numerical data ; Logistic Models ; Pre-Eclampsia/epidemiology ; Pre-Eclampsia/ethnology ; Washington ; Rural Population/statistics & numerical data ; Northwestern United States/epidemiology ; Medically Underserved Area ; Medically Uninsured/ethnology ; Medically Uninsured/statistics & numerical data

Introduction: American Indian/Alaska Native (AI/AN) pregnant people face barriers to health and healthcare that put them at risk of pregnancy complications. Rates of severe maternal morbidity (SMM) among Indigenous pregnant people are estimated to be twice that of non-Hispanic White (NHW) pregnant people.
Methods: Race-corrected Oregon Hospital Discharge and Washington Comprehensive Hospital Abstract Reporting System data were combined to create a joint dataset of births between 2012 and 2016. The analytic sample was composed of 12,535 AI/AN records and 313,046 NHW records. A multilevel logistic regression was used to assess the relationship between community-level, individual and pregnancy risk factors on SMM for AI/AN pregnant people.
Results: At the community level, AI/AN pregnant people were more likely than NHW to live in mostly or completely rural counties with low median household income and high uninsured rates. They were more likely to use Medicaid, be in a high-risk age category, and have diabetes or obesity. During pregnancy, AI/AN pregnant people were more likely to have insufficient prenatal care (PNC), gestational diabetes, and pre-eclampsia. In the multilevel model, county accounted for 6% of model variance. Hypertension pre-eclampsia, and county rurality were significant predictors of SMM among AI/AN pregnant people. High-risk age, insufficient PNC and a low county insured rate were near-significant at p < 0.10.
Discussion: Community-level factors are significant contributors to SMM risk for AI/AN pregnant people in addition to hypertension and pre-eclampsia. These findings demonstrate the need for targeted support in pregnancy to AI/AN pregnant people, particularly those who live in rural and underserved communities.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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NU58DP006385-01 United States CC CDC HHS; NU58DP006385-01 United States CC CDC HHS

Keywords: American Indian/Alaska Native; Health disparities; Maternal health; Severe maternal morbidity
Local Abstract: [plain-language-summary] What is already known on this subject? American Indian and Alaska Native pregnant people face higher rates of severe maternal morbidity and mortality, and the risk is exacerbated for rural Indigenous pregnant people.What this study adds? This publication uses a multilevel model to assess the contribution of community-level factors in severe maternal morbidity risk for American Indian and Alaska Native pregnant people. This analysis highlights the important role that rurality, prenatal care adequacy and access to insurance play in maternal morbidity risk and discusses how those risks are disproportionately felt by American Indian and Alaska Native pregnant people in the Pacific Northwest.

Date Created: 20231113 Date Completed: 20240220 Latest Revision: 20240307

20240307

10.1007/s10995-023-03811-4

37955840