Neighborhood deprivation and severe maternal morbidity in a medicaid-Insured population in Georgia

Christian Freeman; Kaitlyn K. Stanhope; Hannah Wichmann; Denise J. Jamieson; Sheree L. Boulet

doi:10.1080/14767058.2022.2118045

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Neighborhood deprivation and severe maternal morbidity in a medicaid-Insured population in Georgia

Journal article

Peer reviewed

Neighborhood deprivation and severe maternal morbidity in a medicaid-Insured population in Georgia

Christian Freeman, Kaitlyn K. Stanhope, Hannah Wichmann, Denise J. Jamieson and Sheree L. Boulet

The journal of maternal-fetal & neonatal medicine, Vol.35(25), pp.10110-10115

12/12/2022

DOI: 10.1080/14767058.2022.2118045

PMID: 36038962

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https://figshare.com/articles/journal_contribution/Neighborhood_deprivation_and_severe_maternal_morbidity_in_a_medicaid-Insured_population_in_Georgia/20724145View

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Abstract

Despite growing acceptance of the role of context in shaping perinatal risk, data on how neighborhood factors may identify high-risk obstetric patients is limited. In this study, we evaluated the effect of neighborhood deprivation and neighborhood racial composition on severe maternal morbidity (SMM) among persons delivered in a large public health system in Atlanta, Georgia. We conducted a population cohort study using electronic medical record data on all deliveries at Grady Memorial Hospital during 2011-2020. Using residential zip codes, we calculated neighborhood deprivation index based on data from the US Census. We used log-binomial regression with generalized estimating equations to estimate crude and adjusted relative risks (aRR) and 95% confidence intervals (CI) for the association between tertile of neighborhood deprivation and SMM, adjusting for demographic, clinical, and neighborhood-level (racial composition, food desert, and transit access) covariates. Among 25,257 deliveries, 6.2% (1566) experienced SMM. Approximately 24.0%, 32.0%, and 44.0% of women lived in the lowest, middle, and highest tertile of neighborhood deprivation, respectively and 64.9% lived in a neighborhood with majority non-Hispanic Black residents. After adjustment, there was no association between neighborhood deprivation and SMM (aRR: 1.0 (0.8, 1.1)) or residence in a majority Black neighborhood and SMM (aRR:1.0 (0.9, 1.2)). In this safety-net hospital, residence in a high deprivation or majority Black neighborhood did not predict SMM at or following delivery. Individual-level social determinants may better explain variation in risk, particularly in high-burden populations.

neighborhood

pregnancy

risk prediction

Severe maternal morbidity

social determinants of health

Details

Title: Subtitle: Neighborhood deprivation and severe maternal morbidity in a medicaid-Insured population in Georgia
Creators: Christian Freeman - Emory University School of Medicine
Kaitlyn K. Stanhope - Emory University
Hannah Wichmann - Emory University
Denise J. Jamieson - Emory University
Sheree L. Boulet - Emory University
Resource Type: Journal article
Publication Details: The journal of maternal-fetal & neonatal medicine, Vol.35(25), pp.10110-10115
DOI: 10.1080/14767058.2022.2118045
PMID: 36038962
NLM abbreviation: J Matern Fetal Neonatal Med
ISSN: 1476-7058
eISSN: 1476-4954
Publisher: Taylor & Francis
Language: English
Date published: 12/12/2022
Academic Unit: Obstetrics and Gynecology; VPMA - Administration
Record Identifier: 9984446547302771

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6 Times Cited - Web of Science