Asian–White Racial Disparities in Severe Maternal Morbidity within the state of Georgia, 2016-2022 Open Access

Abstract

Background: Over the past two decades, severe maternal morbidity (SMM) has increased in the United States, with disproportionate burden among racial minority groups. Evidence of SMM among Asian women, particularly in high-burden Southern states such as Georgia, remains limited.

Methods: We conducted a retrospective, population-based study of 675,330 delivery hospitalizations in Georgia (2016-2022) using linked vital records and hospital discharge data. SMM was defined using the CDC’s ICD-10 codes for conditions that occur during delivery through 42 days postpartum. The primary exposure was maternal race, with non-Hispanic White as the reference and non-Hispanic Asian as the comparison group. Three primary measures of SMM—including transfusion, excluding transfusion, and only transfusion—were analyzed using logistic regression models. Average marginal effects were estimated, adjusting for sociodemographic, clinical/obstetric, access‑to‑care, and residential characteristics.

Results: Overall, 2.96% of deliveries involved any SMM and equaled 2.41% among Asian and 2.20% among White women (p<.0001). Adjusted models showed Asian women had 65 additional SMM events per 10,000 deliveries (p<.001). When transfusion was excluded, the adjusted Asian–White difference was marginal and statistically non-significant (15 additional events per 10,000; p=.111). For adjusted models analyzing transfusion-only SMM, Asian women had 57 additional events per 10,000 deliveries when compared with White (p<.001). Black women consistently experienced the highest SMM burden across most measures.

Conclusions: In Georgia, Asian women have a modestly higher SMM risk than White women. The findings underscore the importance of refining the operationalization of SMM, disaggregating Asian populations, and including Asian women in maternal health research.

Table of Contents

Chapter I: Introduction and Significance

Chapter 2: Thesis Manuscript

Chapter 3: Expanded Discussion

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Women's Health Severe Maternal Morbidity Maternal Health
Committee Chair / Thesis Advisor	Sarah C. Blake, Emory University
Committee Members	Kathleen Adams, Emory University Anne Dunlop, Emory University Peter Joski, Emory University

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