{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T08:49:49Z","timestamp":1778834989180,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T00:00:00Z","timestamp":1720742400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neonatal-Perinatal Medicine"],"published-print":{"date-parts":[[2024,8,29]]},"abstract":"\n OBJECTIVE:<\/jats:title>\n To examine the association of inpatient maternal mortality with variability in healthcare services delivery such as hospital size, urban\/rural designation, teaching\/non-teaching status, regional location, and insurance coverage.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n This is a pooled, cross-sectional analysis of the National Inpatient Sample (2012\u20132014). Information on maternal demographics, clinical conditions, and birth outcomes were identified using respective ICD9-CM codes. Bivariate and multivariate analysis using logistic regression models were used to describe maternal characteristics and to calculate the risk of mortality with each independent variable<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n The weighted sample included 12,409,939 hospital records (82.6% are 18\u201334-year-old and 49.5% are Caucasians). Maternal death during hospitalization occurred in 1310 cases (12\/100,000 live birth). Women with cardiovascular disorders, hemorrhage or sepsis were 33.6, 4.7, and 5.4 times more likely to suffer inpatient maternal mortality. Compared to small-sized hospitals, delivery at medium or large size hospitals is associated with higher mortality, adjusted odds ratios (aOR) 1.8 (1.4\u20132.3), and 2.2 (1.8\u20132.8), respectively. Adjusted OR for inpatient maternal mortality in urban non-teaching or urban teaching compared to rural hospitals were 2.2 (1.7\u20133.0) and 2.9 (2.2\u20133.9), respectively. Women in the South have higher maternal mortality compared to Northeast, aOR 1.7 (1.5\u20132.1). Women coved with public insurance experience higher inpatient maternal mortality compared to those with private insurance, aOR: 2.6 (2.1\u20133.2) and 1.9 (1.6\u20132.1), respectively.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION:<\/jats:title>\n Factors related to variability in healthcare delivery may play a role in inpatient maternal mortality. Some could be explained by the case mix and the clinical conditions affecting birthing outcomes. A qualitative analysis is needed to explore how these factors relate to increased maternal mortality in certain hospital settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.3233\/npm-240025","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T11:46:36Z","timestamp":1721389596000},"page":"543-553","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Healthcare system variability and inpatient maternal mortality in the United States"],"prefix":"10.1177","volume":"17","author":[{"given":"M.A.","family":"Mohamed","sequence":"first","affiliation":[{"name":"Division of Neonatology, Cleveland Clinic Children\u2019s, Cleveland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, The George Washington University \u2013 Milken Institute School of Public Health, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Abdelatif","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, The George Washington University\/Medical Faculty Associates, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V.","family":"Nandakumar","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Cleveland Clinic Children\u2019s, Cleveland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, The George Washington University \u2013 Milken Institute School of Public Health, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,7,12]]},"reference":[{"key":"ref001","unstructured":"CDC. Maternal and Infant Health. CDC Reproductive Health: https:\/\/www.cdc.gov\/reproductivehealth\/maternalinfanthealth\/infantmortality.htm.2016. Retrieved on February 1\n st\n 2021."},{"key":"ref002","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31470-2"},{"key":"ref003","unstructured":"CDC. Maternal and Infant Health. CDC Pregnancy Mortality Surveillance System: https:\/\/www.cdc.gov\/reproductivehealth\/maternalinfanthealth\/pmss.html. 2016. Retrieved on February 1\n st\n 2021."},{"key":"ref004","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002114"},{"key":"ref005","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.11652"},{"key":"ref006","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003667"},{"key":"ref007","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003157"},{"key":"ref008","author":"Singh GK","journal-title":"Substantial Racial\/Ethnic, Socioeconomic and Geographic Disparities Persist"},{"issue":"502","key":"ref009","first-page":"15","volume":"125","author":"The American College of Obstetriciand and Gynecologists","year":"2015","journal-title":"Obstetric Care Consensus No. 2"},{"key":"ref010","author":"U.S.","journal-title":"Health Resources and Services Administration Maternal and Child Health Bureau"},{"key":"ref011","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0030341"},{"key":"ref012","unstructured":"CDC. Maternal Mortality. Retrieved from CDC Reproductive Health: https:\/\/www.cdc.gov\/nchs\/maternal-mortality\/index.htm. 2018. Retrieved on February 1\n st\n 2021."},{"key":"ref013","unstructured":"Healthcare Cost and Utilization Product (HCUP), Overview. https:\/\/www.hcup-us.ahrq.gov\/overview.jsp. Retrieved on February 1\n st\n 2021."},{"key":"ref014","unstructured":"Healthcare Cost and Utilization Product (HCUP), 2012 database introduction. https:\/\/hcup-us.ahrq.gov\/db\/nation\/kid\/kid_2012_introduction.jsp Retrieved on February 1\n st\n 2021."}],"container-title":["Journal of Neonatal-Perinatal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3233\/NPM-240025","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.3233\/NPM-240025","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3233\/NPM-240025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:44:05Z","timestamp":1777614245000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.3233\/NPM-240025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,12]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,8,29]]}},"alternative-id":["10.3233\/NPM-240025"],"URL":"https:\/\/doi.org\/10.3233\/npm-240025","relation":{},"ISSN":["1934-5798","1878-4429"],"issn-type":[{"value":"1934-5798","type":"print"},{"value":"1878-4429","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,12]]}}}