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Exploring Trends in Severe Maternal Morbidity in the U.S

Author

Listed:
  • Pinka Chatterji
  • Fangning Li
  • Sara Markowitz

Abstract

The incidence of severe maternal morbidity (SMM) in the U.S. has been rising among mothers over time, with especially pronounced increases among Black mothers. In this paper, we examine why this might be happening. Previous literature takes a limited-scope approach by focusing on select variables as determinants of SMM. We take a broader approach and evaluate the contributions of a large set of variables over a long time span to let the data inform us what factors may be most influential in determining SMM. We use inpatient data from 1998-2019 to see how maternal, hospital, and county-level characteristics may be associated with both the rising trends and the racial disparity in SMM. Decomposition methods show that the observed characteristics explain very little of the overall variation of SMM, but account for a substantial share of the Black-White SMM gap. Medical and pregnancy-related comorbid conditions are the largest drivers of the observed variations. The associational findings indicate that focusing on patients with comorbid conditions and delving more deeply into the features of hospital environments may help researchers identify policy-relevant drivers of SMM and SMM disparities.

Suggested Citation

  • Pinka Chatterji & Fangning Li & Sara Markowitz, 2026. "Exploring Trends in Severe Maternal Morbidity in the U.S," NBER Working Papers 35062, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:35062
    Note: CH EH
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    References listed on IDEAS

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    1. Sarah Robinson & Heather Royer & David Silver, 2024. "Geographic Variation in Cesarean Sections in the United States: Trends, Correlates, and Other Interesting Facts," Journal of Labor Economics, University of Chicago Press, vol. 42(S1), pages 219-259.
    2. Stefanie Fischer & Heather Royer & Corey White, 2024. "Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the United States," American Economic Journal: Applied Economics, American Economic Association, vol. 16(3), pages 113-141, July.
    3. E. Kathleen Adams & Sara Markowitz & Michael R. Kramer & Peter J. Joski & Anne L. Dunlop, 2025. "Decomposing Racial Disparities in Severe Maternal Morbidity Within Insurance Groups," Health Economics, John Wiley & Sons, Ltd., vol. 34(10), pages 1749-1772, October.
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    More about this item

    JEL classification:

    • I0 - Health, Education, and Welfare - - General
    • J1 - Labor and Demographic Economics - - Demographic Economics

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