ArticleObstetrics and gynecology2013
Paradoxical trends and racial differences in obstetric quality and neonatal and maternal mortality.
Article in Obstetrics and gynecology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 3 syntheses or guidelines pooled it, 41 citations in OpenAlex.
- Addressing the U.S. maternal health crisis: a systematic review of healthcare access barriers, disparate outcomes, and effective interventions.Frontiers in public health · 2026Pooled it
- Composite neonatal morbidity indicators using hospital discharge data: A systematic review.Paediatric and perinatal epidemiology · 2020Pooled it
- Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States: A Systematic Review.Obstetrics and gynecology · 2020Pooled it
- Monitoring childbirth and immediate postpartum care quality: A scoping review of indicators in high-income countries.PloS one · 2026Article
- "We don't really address the trauma": Patients' Perspectives on Postpartum Care Needs after Severe Maternal Morbidities.Maternal and child health journal · 2024Article
- Retaining the perinatal care workforce: Lessons learned from experienced physicians who no longer attend deliveries.Health services research · 2024Article
- Neonatal Outcomes of Mothers With a Disability.Pediatrics · 2022Article
- Measuring State-Level Racial Inequity in Severe Maternal Morbidity in the Medicaid Population.Maternal and child health journal · 2022Article
- Association between weighted adverse outcome score and race/ethnicity in women and neonates.Journal of perinatology : official journal of the California Perinatal Association · 2021Article
- Development of the genomic inflammatory index (GII) to assess key maternal antecedents associated with placental inflammation.Placenta · 2021Article
- Peripartum racial/ethnic disparities.International anesthesiology clinics · 2021Article
- Article
- Methodology for sampling women at high maternal risk in administrative data.BMC pregnancy and childbirth · 2019Article
- Methods for Measuring Racial Differences in Hospitals Outcomes Attributable to Disparities in Use of High-Quality Hospital Care.Health services research · 2017Article
- Quality of Care and Disparities in Obstetrics.Obstetrics and gynecology clinics of North America · 2017Review
- Racial and Ethnic Disparities in Mode of Anesthesia for Cesarean Delivery.Anesthesia and analgesia · 2016Article
- Factors associated with increased cesarean risk among African American women: evidence from California, 2010.American journal of public health · 2015Article
- Association between hospital-level obstetric quality indicators and maternal and neonatal morbidity.JAMA · 2014Observational
- Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status.Women's health issues : official publication of the Jacobs Institute of Women's HealthArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 2 countries.
Funding
Abstract
objectiveTo evaluate trends by race in Agency for Healthcare Research and Quality obstetric-related quality and safety indicators and their relationships to trends in inpatient maternal and neonatal mortality.
methodsWe used the Nationwide Inpatient Sample from 2000 through 2009 and calculated obstetric hospital quality and patient safety indicators and inpatient maternal and neonatal mortality stratified by race. We examined differences in age and comorbidity-adjusted trends in black compared with white women over time in the United States and by geographic region. Proportions were analyzed by χ2 and trends by regression analysis.
resultsObstetric quality indicators varied by geographic region, but changes over time were consistent for both races. Cesarean deliveries increased similarly for black and white women, and vaginal births after cesarean delivery declined for both races but more rapidly for white women than for black women. Obstetric safety indicators improved over the study period for black and white women, with obstetric trauma decreasing significantly for both groups (28% compared with 35%, respectively) and birth trauma-injury to neonates declining for both, but changes were not significant. In striking contrast, inpatient maternal and neonatal mortality remained relatively constant during the study period, with persistently higher rates of both seen among black compared with white women (12.0 compared with 4.6 per 100,000 deliveries, P<.001 and 6.6 compared with 2.5 per 1,000 births, P<.001, respectively, in 2009).
conclusionImprovements in Agency for Healthcare Research and Quality quality indicators for obstetrics are not reflected in improvements in maternal and neonatal morbidity and mortality and do not explain continued racial disparities for outcomes in pregnancies in black and white women. Quality measures that are related to pregnancy outcomes are needed and these should elucidate obstetric health disparities.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.