Municipality-Level Variation in Severe Maternal Morbidity and Association with Municipal Expenditures in New Jersey
Report Publish Date: November 18, 2021
This journal article describes a study looking at associations between severe pregnancy complications in New Jersey and city spending on services for residents.
Primary Takeaways
The authors found that levels of severe pregnancy complications varied considerably by city. They also found that in cities that spent more on services such as transportation, health, housing, libraries, and welfare, women were less likely to have severe pregnancy complications (a.k.a., severe maternal morbidity, or SMM), compared to women in cities that spent less on resident services. However, in cities that spent more on police, women were more likely to have severe pregnancy complications.
Overview and Objectives
The United States has a high rate of death related to pregnancy, which is often linked to complications of pregnancy, and New Jersey is one of the states with the highest rates of severe pregnancy complications. The authors wanted to know whether severe pregnancy complication rates vary by city in New Jersey. They also wanted to see whether city spending that is directly or indirectly related to health (including during pregnancy) contributes to rates of pregnancy complications.
Hypothesis or Approach
The authors analyzed over a million New Jersey birth files, covering a ten-year period (2008–2018). They matched the birth records to maternal hospital discharge records and data on city spending. They used hospital discharge codes and Centers for Disease Control and Prevention criteria to identify women with severe pregnancy complications.
How This Influences Change
“A major objective of the Maternal Health Action Plan of the US Department of Health and Human Services, released in 2020, was to enhance the targeting of resources by identifying problem spots for maternal morbidity and mortality,” the authors write. “Our findings strongly suggest that surveillance at the municipal level, a level rarely considered in studies of health outcomes, would be important for success in such efforts.”
Research: Go Deeper
Importance: Severe maternal morbidity (SMM) is a major risk factor for maternal mortality, yet little is known about geographic variation in SMM or factors associated with geographical variation at the local level. Municipal governments incur substantial expenditures providing services that are an essential part of residents’ lives, but associations between municipal expenditures and SMM have not been previously examined.
Objective: To investigate variation in rates of SMM across municipalities in New Jersey, the contributions of individual-level characteristics and municipal expenditures to that variation, and associations between municipal expenditures and SMM.
Design, Setting, and Participants: This cross-sectional study analyzed 2008 to 2018 New Jersey birth files linked to maternal hospital discharge records and US Census municipal expenditures data. The birth files contain all birth records for New Jersey, and hospital discharge records contain information from all in-patient hospitalizations in New Jersey over the study period. Birth records were matched to maternal discharge records and expenditures data. Data were analyzed from August 2020 to August 2021.
Exposures: Individual-level characteristics and per capita municipal expenditures on education; public health; fire and ambulance; parks, recreation, and natural resources; housing and community development; public welfare; police; transportation; and libraries.
Main Outcomes and Measures: SMM was identified using diagnosis and procedure codes developed by the Centers for Disease Control and Prevention to measure SMM.
Results: Of 1,001,410 individuals who gave birth in New Jersey hospitals from 2008 to 2018, 19,962 individuals (2.0%) had SMM. There was substantial municipality-level variation in SMM that was not fully explained by demographic characteristics. Municipal expenditures on fire and ambulance, transportation, health, housing, and libraries were negatively associated with SMM; $1000 higher annual expenditures per capita in these categories were associated with 35.4% to 67.3% lower odds of SMM. Expenditures on police were positively associated with SMM.
Conclusions and Relevance: The findings in this study regarding associations between spending on various types of services at the municipal level and SMM, holding constant overall spending, population size, and socioeconomic status at the municipal level, indicate that municipal budget allocation decisions were associated with SMM rates and point to the importance of future research investigating potential causal connections.
JAMA Network Open, November 18, 2021. doi:10.1001/jamanetworkopen.2021.35161
Figure 1. Municipality-Level Severe Maternal Morbidity Rates in New Jersey, 2008-2018
Research Team
This study and report was conducted and created by the following people.
- Muchomba FM
- Teitler J
- Kruse L
- Reichman NE
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