Data Analytics Identifies Health Disparities In Pregnancy Outcomes

While pregnancy outcomes among women with systemic lupus erythematosus (SLE) have improved over time, data analytics indicates that racial and ethnic minority patients are still disproportionately impacted, highlighting health disparities.

 “We’re happy to see pregnancy outcomes improved over time in all of the groups studied, however, improvements were more evident in some groups than others,” lead study author and rheumatologist at Hospital for Special Surgery (HSS) Bella Mehta, MBBS, MS, MD, said in a press release.

“African Americans and Hispanics continue to have poor pregnancy outcomes. Further study is warranted to determine where resources are needed to improve access and care for these patients.”

In the new study, HSS researchers used data from the National Inpatient Sample (NIS) to conduct a retrospective cross-sectional analysis of lupus and pregnancy-related hospital admissions from 2008 to 2017.

Patients with lupus were identified by using ICS-9/10 codes. The research team then examined the population health and pregnancy outcomes for White, Black, Hispanic, and Asian/Native American/Other women. Outcomes included in-hospital maternal mortality, fetal mortality, non-delivery-related admissions, and Cesarean section (C-section).

The researchers discovered that from 2008 to 2017, there were 61,012 SLE pregnancy-related hospitalizations. According to researchers, the median age of pregnant women in the sample was 29 for Black and Hispanic women, 30 for White women, and 31 for Asian/Native American/Other women. 

Additionally, Black and Hispanic women were the most likely to be on Medicaid (51 and 49 percent), compared to White (30 percent) and Asian/Native American/Other Women (33 percent).

During the 10-year study period, researchers saw fetal mortality and non-delivery-related admissions and C-section rates decrease among all racial/ethnic groups. Additionally, maternal mortality rates were very low throughout the study period, with none observed among the White population.

Overall fetal mortality declined in all racial/ethnic groups, with a significantly larger reduction in Hispanic (from 291 in 2008-2009 to 101 in 2016-2017 per 10,000 admissions) and Asian/Native American/Other populations (from 267 in 2008-2009 to no observations in 2016-2017 per 10,000 admissions) versus White (from 136 in 2008-2009 to 108 in 2016-2017 per 10,000 admissions) and Black populations (from 385 in 2008-2009 to 308 in 2016-2017 per 10,000 admissions).

The latest dataset from 2017 shows the Black women continued to have worse fetal mortality than Hispanic or White women, while Asian/Native American/Other populations have the least fetal mortality. Additionally, the 2017 data indicates Black women had the most nom-delivery admissions, followed by Hispanic, Asian/Native American/Other, and White women.

Black women also saw the highest C-section rates, followed by White, Asian/Native American/Other, and Hispanic women.

“We have learned over the years that patients with lupus can become pregnant but need to do so in a certain way. That is, they should have quiet disease activity at conception and they shouldn’t become pregnant if they have serious internal organ damage such as renal failure,” said study co-author Lisa R. Sammaritano, MD, a rheumatologist at HSS.

“What this study shows is there is still a persistent disparity between non-Caucasian ethnic groups and Caucasians in terms of pregnancy outcomes in women with lupus, but both groups have had improvement over 10 years.”

Sammaritano explained while it’s good to see improvements across racial and ethnic groups, researchers must identify why these health disparities exist. “This kind of large database study is very useful in looking at this type of problem across the country as a whole, rather than a study focused on a single hospital system, as most other studies do.”