The role of pregnancy- related comorbidities in maternal health disparities among Asian American/Pacific Islanders
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Background
Asian American/ Pacific Islander (AAPI) groups experience different burdens of severe maternal morbidity (SMM) and pregnancy-related comorbidities that contribute to SMM. We sought to estimate counterfactual disparities for selected AAPI groups, separating out the pathway that includes these comorbidities.
Methods
We used linked birth certificates and hospital discharge data from births in California from 2011-2020. We examined the presence of pregnancy-related comorbidities (gestational hypertension and diabetes, pre-eclampsia) as a mediator between race/ethnicity and severe maternal morbidity. We used marginal structural models to estimate total effects and controlled direct effects (CDEs) (adjusted for maternal characteristics) for each AAPI group with Non-Hispanic Whites as the referent group.
Results
Our sample included n=1,849,698 births. All AAPI groups had higher prevalences of comorbidities compared to Non-Hispanic Whites (e.g., White: 15.7%, Chinese: 17.9%: Indian: 25.2%, Filipina: 28.8%, Pacific Islander: 23.9%). Filipinas and Pacific Islanders experienced the largest disparities in SMM (e.g., Total effect risk ratios (RR) Chinese: 1.03 (95% Confidence Interval (CI): 1.00, 1.07); Filipina: 1.64 (95% CI: 1.58, 1.70)). Under M=1 conditions, where everyone experienced comorbidities, disparities were eliminated for Chinese and Indian groups and alleviated for Filipinas and Pacific Islanders (e.g., CDE Chinese: 0.75 (95% CI: 0.69, 0.81); Filipina: 1.21 (95% CI: 1.13, 1.29)). Under M=0, disparities remained similar to the total effect (e.g., CDE Chinese: 1.14 (95% CI: 1.09, 1.19); CDE Filipina: 1.64 (95% CI: 1.53, 1.71))
Conclusions
Pregnancy-related comorbidities contributed substantially to disparities for AAPI groups. Disparities persisted for Filipinas and Pacific Islanders, suggesting a need for tailored interventions.
