Increased maternal morbidity and mortality among Asian American and Pacific Islander women in the military health system

Patrizia C Grob; Rachel R Tindal; Kathleen R Lundeberg; Jameaka L Hamilton; Veronica M Gonzalez-Brown; Erin A Keyser

doi:10.1016/j.xagr.2023.100212

Increased maternal morbidity and mortality among Asian American and Pacific Islander women in the military health system

AJOG Glob Rep. 2023 Apr 14;3(2):100212. doi: 10.1016/j.xagr.2023.100212. eCollection 2023 May.

Authors

Patrizia C Grob¹, Rachel R Tindal², Kathleen R Lundeberg³, Jameaka L Hamilton⁴, Veronica M Gonzalez-Brown⁵, Erin A Keyser⁵

Affiliations

¹ Rocky Vista University College of Osteopathic Medicine, Parker, CO (Dr Grob).
² University of Alabama Heersink School of Medicine, Birmingham, AL (Dr Tindal).
³ College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA (Dr Lundeberg).
⁴ Department of Gynecologic Surgery & Obstetrics, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, Las Vegas, NV (Dr Hamilton).
⁵ Department of Gynecologic Surgery & Obstetrics, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Fort Sam Houston, TX (Drs Gonzalez-Brown and Keyser).

Abstract

Background: Rates of maternal morbidity and mortality experienced by women in the United States have been shown to vary significantly by race, most commonly attributed to differences in access to healthcare and socioeconomic status. Recent data showed that Asian Pacific Islanders have the highest rate of maternal morbidity despite having a higher socioeconomic status. In the military, women of all races are granted equal access to healthcare, irrespective of socioeconomic class. We hypothesized that within the military, there would be no racial disparities in maternal outcomes because of universal healthcare.

Objective: This study aimed to evaluate if universal access to healthcare, as seen in the military healthcare system, leads to similar rates of maternal morbidity regardless of racial or ethnic background.

Study design: This was a retrospective cohort study of data from the National Perinatal Information Center reports obtained from participating military treatment facilities from April 2019 to March 2020 and included 34,025 deliveries. We compared racial differences in the incidence of each of the following 3 outcomes: postpartum hemorrhage, severe maternal morbidity among women with postpartum hemorrhage including transfusion, and severe maternal morbidity among women with postpartum hemorrhage excluding transfusion.

Results: A total of 41 military treatment facilities (a list of participating military treatment facilities are provided in the Appendix) provided data that were included. There was an increased rate of postpartum hemorrhage (relative risk, 1.73; 95% confidence interval, 1.45-2.07), severe maternal morbidity including transfusion (relative risk, 1.22; 95% confidence interval, 0.93-1.61), and severe maternal morbidity excluding transfusion (relative risk, 1.97; 95% confidence interval, 1.02-3.8) among Asian Pacific Islander women when compared with Black or White women.

Conclusion: Even with equal access to healthcare in the military, Asian Pacific Islander women experience statistically significant increased rates of postpartum hemorrhage and severe maternal morbidity excluding transfusion when compared with Black or White women. The increased rates of severe maternal morbidity including transfusion were not statistically significant.

Keywords: Asian Pacific Islander; maternal morbidity and mortality; military health system; postpartum hemorrhage; racial disparities; severe maternal morbidity; socioeconomic status.