The Impact Of Environmental And Social Characteristics On Severe Maternal Morbidity: A Spatiotemporal Analysis In South Carolina

Severe Maternal Morbidity (SMM) occurs when a woman nearly dies during pregnancy or delivery. Despite its increasing prevalence, there is little research that evaluates geographic patterns of SMM and the underlying social determinants that influence likelihood. This study aims to examine the spatial clustering of SMM across South Carolina and its associations with place-based social and environmental factors. Hospitalized delivery records from 1999 to 2017 were provided by the South Carolina Department of Health and Environmental Control and identified as SMM based on diagnostic codes. Kulldorff's spatial scan statistic located areas with abnormally high rates of SMM with and without blood transfusions. SMM patients inside and outside risk clusters were compared using Generalized Estimating Equations (GEE) analysis to determine underlying risk factors. Results show that patient (e.g., obesity, minority status) and community-level characteristics (e.g., high temperatures) impact an individual’s SMM risk. Most importantly, living in racially segregated low-income communities resulted in the highest potential for SMM risk. As SMM rises in the United States, it is important that vulnerable populations are accurately targeted. This study spatially identifies SMM patterns and connects individual and area-level variables to likelihood.