A new study from Columbia University’s Mailman School of Public Health and Columbia’s Vagelos College of Physicians and Surgeons provides strong evidence to support diversifying the health care workforce as a remedy for addressing racial and ethnic disparities in health care. maternal health outcomes, and a call to action to improve maternal health. Health. The researchers focused on registered nurses in particular because they are critical to comprehensive maternal health care and are the frontline health care providers involved in early recognition of warning signs of maternal complications. Late recognition of these warning signs has been repeatedly identified as one of the main contributors to preventable maternal deaths. The study is published online at American Journal of Obstetrics and Gynecology MFM.
“Until now, evidence linking healthcare workforce diversity to better maternal health outcomes was scant,” said Jean Guglielminotti, MD, PhD, Department of Anesthesiology at Columbia P&S, and first author. Compared to non-Hispanic white people who gave birth, racial and ethnic minorities were up to three times more likely to experience life-threatening complications during pregnancy, childbirth and the postpartum period, according to Guglielminotti.
Black and Native American people were at particularly high risk for serious adverse maternal outcomes. “Structural racism in public policy, institutional practices, cultural representations, and other norms works to perpetuate the inequalities of racial groups and what we believe contributes to these disparities in serious adverse maternal outcomes, regardless of poverty and other social determinants of health,” Guglielminotti said.
The researchers analyzed 2017 US birth certificate data from all 50 states and the District of Columbia. The proportions of registered nurses who were racial and ethnic minorities in each state were drawn from the American Community Survey and classified into three groups: 1) low state racial and ethnic diversity (3.3-14 percent); 2) diversity of intermediate states (14-32 percent); and 3) high statewide diversity (32-68 percent). Serious Adverse Maternal Outcomes (SAMOs) are defined as eclampsia, blood transfusion, hysterectomy, or intensive care unit admission, which are recorded in specific checkboxes or
Of the 3,668,813 birth certificates studied, 29,174 registered SAMO or 0.8 percent. The most frequent complication recorded was blood transfusion (0.39 percent), followed by eclampsia (0.28 percent), ICU admission (0.16 percent), and hysterectomy (0.05 percent). hundred). Native American mothers had the highest incidence of SAMO (1.75 percent), followed by black mothers (1 percent), mothers of more than one race (1 percent), white mothers (0.74 percent cent), Asian/Pacific Islander mothers (0.73 percent), and Hispanic mothers (0.7 percent).
The statewide average proportion of RNs who were racial and ethnic minorities was 22 percent, and ranged from 3 percent in Maine to 68 percent in Hawaii. Compared with giving birth in states with the lowest diversity of nurses, giving birth in states with the highest diversity of nurses was associated with a 32% lower risk of SAMO for white mothers, 20% for African-American mothers, 31% for Hispanic mothers and 50 percent for Asian and Pacific Islander mothers. SAMO risk was not significantly reduced for Native American mothers or mothers of more than one race, primarily due to small sample sizes in these groups.
“A racially diverse nursing workforce can help reduce implicit provider bias and improve communication and trust between patients and physicians,” said Guohua Li, MD, DrPH, professor of epidemiology and anesthesiology at Columbia Mailman School and P&S, and lead author. “Perinatal care is a team effort. Frontline nurses play a key role in ensuring the safety and well-being of mothers and their newborns.”
“Our study provides strong evidence to support the recommendation to diversify the health care workforce as a strategy to address racial and ethnic disparities in maternal health outcomes,” Li noted. “We hope that this research will help facilitate the development of intervention programs to reduce racial and ethnic disparities in maternal health outcomes,” said Guglielminotti.
Co-authors are Golden Samari, Columbia Mailman School of Public Health, and Alexander Friedman, Allison Lee, and Ruth Landau, Columbia Vagelos College of Physicians and Surgeons.
The study was presented at the 54the Annual Meeting of the Society for Obstetric Anesthesia and Perinatology in Chicago.
