Abstract
Objective This study aimed to determine health care disparities in evaluation and admission
among underserved racial and ethnic minority groups presenting with cardiovascular
complaints during the first postpartum year according to patient and provider demographics.
Study Design A retrospective cohort study was performed on all postpartum patients who sought
emergency care between February 2012 and October 2020 in a large urban care center
in Southeastern Texas. Patient information was collected according to International
Classification of Diseases 10th Revision codes and individual chart analysis. Race,
ethnicity, and gender information were self-reported for both patients on hospital
enrollment forms and emergency department (ED) providers on their employment records.
Statistical analysis was performed with logistic regression and Pearson's chi-square
test.
Results Of 47,976 patients who delivered during the study period, 41,237 (85.9%) were black,
Hispanic, or Latina and 490 (1.1%) presented to the ED with cardiovascular complaints.
Baseline characteristics were similar between groups; however, Hispanic or Latina
patients were more likely to have had gestational diabetes mellitus during the index
pregnancy (6.2 vs. 18.3%). There was no difference in hospital admission between groups
(17.9% black vs. 16.2% Latina or Hispanic patients). There was no difference in the
hospital admission rate by provider race or ethnicity overall (p = 0.82). There was no difference in the hospital admission rate when a patient was
evaluated by a provider of a different race or ethnicity (relative risk [RR] = 1.08,
CI: 0.6–1.97). There was no difference in the rate of admission according to the self-reported
gender of the provider (RR = 0.97, CI: 0.66–1.44).
Conclusion This study illustrates that disparities did not exist in the management of racial
and ethnic minority groups who presented to the ED with cardiovascular complaints
during the first postpartum year. Patient–provider discordance in race or gender was
not a significant source of bias or discrimination during the evaluation and treatment
of these patients.
Key Points
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Adverse postpartum outcomes disproportionately affect minorities.
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There was no difference in admissions between minority groups.
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There was no difference in admissions by provider race and ethnicity.
Keywords
disparities - inequities - minorities - underserved - postpartum mortality - pregnancy-related
mortality - patient–physician concordance
