Health Equity/Community Health
Poster Session 4
Adina R. Kern-Goldberger, MD, MPH, MSCE
Assistant Professor, Maternal-Fetal Medicine
Cleveland Clinic Lerner College of Medicine
Cleveland, OH, United States
Kirat Sandhu, MD
Resident
Cleveland Clinic Foundation
Cleveland, OH, United States
Stacey Ehrenberg, MD
Cleveland Clinic Foundation
Cleveland, OH, United States
Cara D. Dolin, MD, MPH
Assistant Professor of Obstetrics and Gynecology
Cleveland Clinic
Pepper Pike, OH, United States
Social determinants of health (SDoH) impact risk for maternal and perinatal morbidity and contribute to health inequity. Systematic screening for SDoH in routine pregnancy care could target “wrap around” services to improve long-term wellness and short-term obstetric outcomes. This study investigates the association between SDoH and pregnancy outcomes.
Study Design:
This retrospective cohort study evaluated all patients who delivered 1/1/18-6/30/23 in a multi-hospital health system in a single metropolitan area and underwent SDoH screening. The primary exposure, “socioeconomic insecurity” (SEI) was a composite of SDoH elements from the screening template including housing instability, poor access to transportation, financial strain, food insecurity, and intimate partner violence. The primary outcome was preterm birth < 37 weeks (secondary outcomes in Table). All data were extracted from the EMR, patient demographics and clinical characteristics were compared in univariable analysis, and multivariable logistic regression was used to evaluate the association of SEI with outcomes.
Results:
15,763 patients had comprehensive SDoH screening (23.4% of deliveries, with 20.2% screening positive for at least one element of the composite). Patients with SEI were more likely to be younger, Black, Hispanic, insured by Medicaid, and multiparous, and to have higher pregravid BMI (mean 30.0 [8.1] vs 27.6 [6.8]) and a high obstetric co-morbidity index (> 6; 6.9 vs 4.3%) [p < 0.01 for all]. Adjusted analysis demonstrated higher odds of preterm birth < 37 weeks for patients with SEI, even when accounting for other relevant health determinants, though not for the other outcomes [Table].
Conclusion:
Socioeconomic security may independently increase risk for preterm birth and could amplify the risks levied by other social determinants such as race. Universal SDoH screening in pregnancy could better identify patients at risk of preterm birth and direct appropriate social services to optimize outcomes.