Understanding racial disparities in severe maternal morbidity using Bayesian network analysis

PLoS One. 2021 Oct 27;16(10):e0259258. doi: 10.1371/journal.pone.0259258. eCollection 2021.

Abstract

Previous studies have evaluated the marginal effect of various factors on the risk of severe maternal morbidity (SMM) using regression approaches. We add to this literature by utilizing a Bayesian network (BN) approach to understand the joint effects of clinical, demographic, and area-level factors. We conducted a retrospective observational study using linked birth certificate and insurance claims data from the Arkansas All-Payer Claims Database (APCD), for the years 2013 through 2017. We used various learning algorithms and measures of arc strength to choose the most robust network structure. We then performed various conditional probabilistic queries using Monte Carlo simulation to understand disparities in SMM. We found that anemia and hypertensive disorder of pregnancy may be important clinical comorbidities to target in order to reduce SMM overall as well as racial disparities in SMM.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Arkansas
  • Bayes Theorem
  • Female
  • Health Status Disparities*
  • Humans
  • Insurance / statistics & numerical data
  • Maternal Health / ethnology*
  • Maternal Health / statistics & numerical data
  • Middle Aged
  • Minority Health / statistics & numerical data
  • Morbidity
  • Pregnancy
  • Pregnancy Complications / epidemiology
  • Pregnancy Complications / ethnology*