For a study, researchers sought to describe disparities in pregnancy-related mortality at the county level as a function of socio-spatial factors. They performed a cross-sectional multilevel analysis of all pregnancy-related fatalities and all live births in the Pregnancy Mortality Surveillance System from 2011 to 2016 for non-Hispanic Black, Hispanic (all races), and non-Hispanic White women aged 15–44 years. The exposures comprised 31 conceptually based, county-specific sociospatial variables gathered from publically available data sources and classified into demographic; general, reproductive, and behavioral health; social capital and support; and socioeconomic settings categories. The absolute difference in county-level pregnancy-related mortality ratios (deaths per 100,000 live births) per 1-unit increase in the median absolute difference between women living in counties with higher versus lower levels of each sociospatial indicator overall and stratified by race and ethnicity was calculated.

The rate of pregnancy-related death differed by county, race, and ethnicity. Independent of maternal age, population size, or Census area, several sociospatial factors were linked to county-specific pregnancy-related death rates. The most damaging indicators across domains were the proportion of low-birth-weight newborns (RD 6.44; 95% CI 5.36–7.51), the percentage of jobless adults (RD 4.98; 95% CI 3.91–6.05), and food insecurity (RD 4.92; 95% CI 4.14–5.70). Higher median household income (RD 2.76; 95% CI 3.28 to 2.24), the proportion of college-educated individuals (RD 2.28; 95% CI 2.81), and the percentage of owner-occupied homes (RD 1.66; 95% CI 2.29 to 1.03) were the strongest protective variables. Race and ethnicity had different magnitudes of these correlations.

The study found sociospatial markers of pregnancy-related mortality, as well as a link between pregnancy-related fatalities and location of residence, both overall and by race and ethnicity. Understanding the context of pregnancy-related death at the county level might be a crucial step in generating public health evidence to guide local action to minimize pregnancy-related mortality.

Reference:journals.lww.com/greenjournal/Fulltext/2022/05000/County_Level_Associations_Between.17.aspx