TY - JOUR
T1 - Socioethnic disparities in severe maternal morbidity in Western Australia
T2 - a statewide retrospective cohort study
AU - Adane, Akilew A.
AU - Farrant, Brad M.
AU - Marriott, Rhonda
AU - White, Scott W.
AU - Bailey, Helen D.
AU - Shepherd, Carrington C.J.
PY - 2020/11/4
Y1 - 2020/11/4
N2 - OBJECTIVES: To assess the scale of ethnic inequalities in severe maternal morbidity (SMM) rates and quantify the contribution of maternal characteristics to these disparities. DESIGN: Retrospective cohort study. SETTING: Whole-of-population linked administrative data from 2002 to 2015 in Western Australia. PARTICIPANTS: Women with 410 043 birth events (includes all births from the same pregnancy) of 20 weeks' or more gestation, including terminations for congenital anomalies. PRIMARY AND SECONDARY OUTCOME MEASURES: Women with SMM were identified based on a composite indicator of SMM using diagnosis and procedure codes developed for use in routinely collected data. Mothers were classified into seven ethnic groups, based on their reported ethnic origin. The associations between maternal ethnic origin and SMM were examined using a log-binomial model, which estimates risk ratios (RRs) and 95% CIs. The Blinder-Oaxaca decomposition technique was employed to partition the disparity in SMM between Aboriginal and Caucasian populations into 'explained' and 'unexplained' components. RESULTS: During the study period, 9378 SMM cases were documented. In the adjusted model, Aboriginal (RR 1.73, 95% CI 1.59 to 1.87), African (RR 1.64, 95% CI 1.43 to 1.89) and 'other' ethnicity (RR 1.49, 95% CI 1.37 to 1.63) women were at significantly higher risk of SMM compared with Caucasian women. Teenage and older mothers and socioeconomically disadvantaged women were also at greater risk of SMM. Differences in sociodemographic characteristics explained 33.2% of the disparity in SMM between Aboriginal and Caucasian women. CONCLUSIONS: There are distinct disparities in SMM by ethnicity in Western Australia, with a greater risk among Aboriginal and African women. While improvements in SES and a reduction in teenage pregnancy can potentially support a sizeable reduction in SMM rate inequalities, future research should investigate other potential pathways and targeted interventions to close the ethnicity disparity.
AB - OBJECTIVES: To assess the scale of ethnic inequalities in severe maternal morbidity (SMM) rates and quantify the contribution of maternal characteristics to these disparities. DESIGN: Retrospective cohort study. SETTING: Whole-of-population linked administrative data from 2002 to 2015 in Western Australia. PARTICIPANTS: Women with 410 043 birth events (includes all births from the same pregnancy) of 20 weeks' or more gestation, including terminations for congenital anomalies. PRIMARY AND SECONDARY OUTCOME MEASURES: Women with SMM were identified based on a composite indicator of SMM using diagnosis and procedure codes developed for use in routinely collected data. Mothers were classified into seven ethnic groups, based on their reported ethnic origin. The associations between maternal ethnic origin and SMM were examined using a log-binomial model, which estimates risk ratios (RRs) and 95% CIs. The Blinder-Oaxaca decomposition technique was employed to partition the disparity in SMM between Aboriginal and Caucasian populations into 'explained' and 'unexplained' components. RESULTS: During the study period, 9378 SMM cases were documented. In the adjusted model, Aboriginal (RR 1.73, 95% CI 1.59 to 1.87), African (RR 1.64, 95% CI 1.43 to 1.89) and 'other' ethnicity (RR 1.49, 95% CI 1.37 to 1.63) women were at significantly higher risk of SMM compared with Caucasian women. Teenage and older mothers and socioeconomically disadvantaged women were also at greater risk of SMM. Differences in sociodemographic characteristics explained 33.2% of the disparity in SMM between Aboriginal and Caucasian women. CONCLUSIONS: There are distinct disparities in SMM by ethnicity in Western Australia, with a greater risk among Aboriginal and African women. While improvements in SES and a reduction in teenage pregnancy can potentially support a sizeable reduction in SMM rate inequalities, future research should investigate other potential pathways and targeted interventions to close the ethnicity disparity.
KW - obstetrics
KW - perinatology
KW - public health
UR - http://www.scopus.com/inward/record.url?scp=85095677513&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-039260
DO - 10.1136/bmjopen-2020-039260
M3 - Article
C2 - 33148750
AN - SCOPUS:85095677513
SN - 2044-6055
VL - 10
SP - e039260
JO - BMJ Open
JF - BMJ Open
IS - 11
M1 - e039260
ER -
