Impact of Social Determinants of Health on Severe Maternal Morbidity and Pregnancy Outcomes
Author(s)
Anna Wang, PhD, Francis Concannon, BS, Daria Eremina, PhD, Douglas Londono, PhD;
PurpleLab, Wayne, PA, USA
PurpleLab, Wayne, PA, USA
Presentation Documents
OBJECTIVES: To evaluate the effect of SDOH on pregnancy outcomes and SMM using a comprehensive dataset from PurpleLab’s healthcare claims repository.
METHODS: Retrospective cohort study using healthcare claims data from January 1, 2016, to May 5, 2023. Women aged 18-49 from PurpleLab’s healthcare claims repository, which includes a comprehensive collection of medical and pharmacy claims data across the United States. Population-based sample of women aged 18-49 having experienced one of three pregnancy outcomes: full-term delivery, miscarriage, or termination. SDOH variables included race, ethnicity, education, occupation, income, and marital status, as they relate to pregnancy outcomes and SMM. Odds ratios calculated by logistic regression models and hazard ratios calculated by Cox proportional hazards models.
RESULTS: Delivery vs. Termination: Multivariate logistic regression indicated that African American women had a 65% increased likelihood of termination compared to White women (Odds Ratio [OR]: 1.65), while Asian women had a 57% increased likelihood (OR: 1.57). Married women were 30% less likely to terminate a pregnancy compared to single women (OR: 0.70). Non-Hispanic women were 41% less likely to terminate a pregnancy compared to Hispanic women. Delivery vs. Miscarriage: African American women had a 17% increased likelihood of experiencing a miscarriage compared to White women (OR: 1.17). Married women were 9% less likely to experience a miscarriage compared to single women (OR: 0.91). Retired women had a 6% higher likelihood of miscarriage compared to White Collar workers (OR: 1.06). SMM Risk: Coxproportional hazards model analyses revealed a 20% higher risk of SMM within 42 days post full-term delivery for African American women compared to White women (Hazard Ratio [HR]: 1.20).
CONCLUSIONS: SDOH are critical determinants of pregnancy outcomes and SMM risk, with African American women experiencing significantly higher risks. These disparities underscore the need for targeted interventions to SDOH-related inequities in maternal health.
METHODS: Retrospective cohort study using healthcare claims data from January 1, 2016, to May 5, 2023. Women aged 18-49 from PurpleLab’s healthcare claims repository, which includes a comprehensive collection of medical and pharmacy claims data across the United States. Population-based sample of women aged 18-49 having experienced one of three pregnancy outcomes: full-term delivery, miscarriage, or termination. SDOH variables included race, ethnicity, education, occupation, income, and marital status, as they relate to pregnancy outcomes and SMM. Odds ratios calculated by logistic regression models and hazard ratios calculated by Cox proportional hazards models.
RESULTS: Delivery vs. Termination: Multivariate logistic regression indicated that African American women had a 65% increased likelihood of termination compared to White women (Odds Ratio [OR]: 1.65), while Asian women had a 57% increased likelihood (OR: 1.57). Married women were 30% less likely to terminate a pregnancy compared to single women (OR: 0.70). Non-Hispanic women were 41% less likely to terminate a pregnancy compared to Hispanic women. Delivery vs. Miscarriage: African American women had a 17% increased likelihood of experiencing a miscarriage compared to White women (OR: 1.17). Married women were 9% less likely to experience a miscarriage compared to single women (OR: 0.91). Retired women had a 6% higher likelihood of miscarriage compared to White Collar workers (OR: 1.06). SMM Risk: Coxproportional hazards model analyses revealed a 20% higher risk of SMM within 42 days post full-term delivery for African American women compared to White women (Hazard Ratio [HR]: 1.20).
CONCLUSIONS: SDOH are critical determinants of pregnancy outcomes and SMM risk, with African American women experiencing significantly higher risks. These disparities underscore the need for targeted interventions to SDOH-related inequities in maternal health.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
RWD141
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Reproductive & Sexual Health