Journal article
Ethnic disparities in severe maternal morbidity and the contribution of deprivation: a population-based causal analysis
- Abstract:
-
Objective: To investigate the association between ethnicity and severe maternal morbidity (SMM) in England and the mediating effects of neighbourhood-level socioeconomic deprivation across detailed ethnic groups.
Design: Population-based nationwide cohort study using English Hospital Episode Statistics Admitted Patient Care (HES APC) data.
Setting: All hospital births in National Health Service (NHS) facilities in England between January 1st, 2013, and March 31st, 2023. Population A cohort of 3,839,156 women aged 10–55 years with births of ≥20 weeks’ gestation.
Methods: Multivariable fixed and mixed-effects Poisson regression models were used to estimate adjusted risk ratios (RR) for SMM across ten ethnic groups compared to White women and for each ethnic group in different deprivation quintiles compared to White women in the least deprived neighbourhoods, respectively. Causal mediation analysis was used to calculate the proportion of the association mediated by deprivation.
Main Outcome Measures: The modified English Maternal Morbidity Outcome Indicator (EMMOI), a composite outcome of SMM.
Results: Minoritised ethnic groups experienced higher SMM risks than White women, with highest risk for Black African women (RR 1.96, 95% confidence interval [CI]: 1.82-2.02) and Bangladeshi women (RR 1.97, 95% CI: 1.88-2.07) compared to White women. The strength of the association varied across ethnic subgroups. Most of the effect of ethnicity on SMM was not mediated by deprivation, with the proportion mediated varying from 11-29%.
Conclusions: Deprivation plays a minor role in ethnic disparities in SMM. Policies are needed to address the unique challenges faced by minoritised ethnic women to reduce SMM.
Funding: Academy of Medical Sciences (grant ref. SGL030/1007). MK is an NIHR Senior Investigator (grant ref. NIHR303806).
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
-
-
(Preview, Version of record, pdf, 326.4KB, Terms of use)
-
- Publisher copy:
- 10.1111/1471-0528.18254
Authors
- Publisher:
- Wiley
- Journal:
- BJOG: An International Journal of Obstetrics & Gynaecology More from this journal
- Volume:
- 123
- Issue:
- 13
- Pages:
- 2131-2137
- Publication date:
- 2025-06-13
- Acceptance date:
- 2025-05-30
- DOI:
- EISSN:
-
1471-0528
- ISSN:
-
1470-0328
- Language:
-
English
- Keywords:
- Pubs id:
-
2128188
- Local pid:
-
pubs:2128188
- Deposit date:
-
2025-06-05
- ARK identifier:
Terms of use
- Copyright holder:
- Geddes-Barton et al
- Copyright date:
- 2025
- Rights statement:
- © 2025 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
If you are the owner of this record, you can report an update to it here: Report update to this record