Bayesian mediation modeling of racial disparity for maternal birth outcomes in United States

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Published Sep 30, 2024
DOI: https://doi.org/10.18103/mra.v12i9.5858

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Main Article Content

James Thompson
College of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station TX USA 77843-4475

Abstract

Background: In the United States, racial disparities for adverse maternal health outcomes persist, and the causes remain unknown. The disparities for women of Black ethnicity include increased risk of gestational hypertension, hypertension eclampsia, cesarean section, and admission to an Intensive Care Unit, and reduced risk of parturition induction. Without evaluating racial disparity, studies identify one cause of these conditions as the interaction between pre-gestational body mass index and gestational weight gain. What has not been determined is how body mass index and gestational weight gain contribute to racial disparity. The study’s objective was to determine if the interaction between body mass index and gestational weight gain can explain the racial disparity in five maternal outcomes.


Methods: The approach involved mediation analysis by performing Bayesian estimation of potential outcomes for each combination of causes. Causes included risk of Black ethnicity, body mass index, and gestational weight gain.


Results: Improving both body mass index and gestational weight gain to what is considered optimal would increase the racial disparity for gestational hypertension by 19.2%, have a non-significant effect on racial disparity for hypertension eclampsia, reduce the racial advantage for Black women receiving induction by 16.9%, and reduce the racial disadvantage for delivery by cesarean and admission to an Intensive Care Unit by 49.9% and 36.9%, respectively.


Conclusion: Preventive programs can have a wide range of effects on racial disparity, from decreasing to increasing the disparity. Implementing the mediation evaluation approach illustrated here would optimize clinical decisions, guide public health policy, and eventually mitigate racial mistrust.

Keywords: maternal; health disparity; mediation; Bayesian; body mass index; gestational weight gain.

Article Details

How to Cite
THOMPSON, James. Bayesian mediation modeling of racial disparity for maternal birth outcomes in United States. Medical Research Archives, [S.l.], v. 12, n. 9, sep. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5858>. Date accessed: 04 oct. 2024. doi: https://doi.org/10.18103/mra.v12i9.5858.
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Issue
Vol 12 No 9 (2024): Vol 12 No 9 (2024): September ISSUE, Issue 9, VOl.12
Section
Research Articles

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References

1. Montalmant KE, Ettinger AK. The Racial Disparities in Maternal Mortality and Impact of Structural Racism and Implicit Racial Bias on Pregnant Black Women: A Review of the Literature. J Racial Ethn Health. 2023.

2. Hailu EM, Maddali SR, Snowden JM, Carmichael SL, Mujahid MS. Structural racism and adverse maternal health outcomes: A systematic review. Health Place. 2022;78.

3. Thompson JA, Suter MA. Estimating racial health disparities among adverse birth outcomes as deviations from the population rates. Bmc Pregnancy Childb. 2020;20(1):7.

4. Thompson AM, Thompson JA. An evaluation of whether a gestational weight gain of 5 to 9kg for obese women optimizes maternal and neonatal health risks. Bmc Pregnancy Childb. 2019; 19.

5. VanderWeele TJ. Explanation in causal inference : methods for mediation and interaction. New York: Oxford University Press; 2015.

6. ACOG. Committee opinion: weight gain during pregnancy. Obstet Gynecol. 2013;121(1): 210-212.

7. Zhang Y, Lu M, Yi Y, et al. Influence of maternal body mass index on pregnancy complications and outcomes: a systematic review and meta-analysis. Front Endocrinol. 2024;15.

8. Mackeen AD, Boyd VE, Schuster M, Young AJ, Gray C, Angras K. The impact of prepregnancy body mass index on pregnancy and neonatal outcomes. J Osteopath Med. 2024.

9. Steffen HA, Swartz SR, Kenne KA, Wendt LH, Jackson JB, Rysavy MB. Increased Maternal BMI at Time of Delivery Associated with Poor Maternal and Neonatal Outcomes. Am J Perinat. 2024.

10. Zugna D, Popovic M, Fasanelli F, Heude B, Scelo G, Richiardi L. Applied causal inference methods for sequential mediators. Bmc Med Res Methodol. 2022;22(1).

11. Tai AS, Lin SH. Multiply robust estimation of natural indirect effects with multiple ordered mediators. Stat Med. 2024;43(4):656-673.

12. Tai AS, Lin SH. Integrated multiple mediation analysis: A robustness-specificity trade-off in causal structure. Stat Med. 2021;40(21):4541-4567.

13. Steen J, Loeys T, Moerkerke B, Vansteelandt S. Flexible Mediation Analysis With Multiple Mediators. Am J Epidemiol. 2017;186(2):184-193.

14. Loh WW, Moerkerke B, Loeys T, Vansteelandt S. Disentangling indirect effects through multiple mediators without assuming any causal structure among the mediators. Psychol Methods. 2022;27 (6):982-999.

15. Hao W, Song PXK. A Simultaneous Likelihood Test for Joint Mediation Effects of Multiple Mediators. Stat Sinica. 2023;33(4):2305-2326.

16. Attia J, Holliday E, Oldmeadow C. A proposal for capturing interaction and effect modification using DAGs. Int J Epidemiol. 2022;51(4):1047-1053.

17. Thompson J. Mediation Analysis of Racial Disparity for Infant Mortality Using Bayesian Estimation of Potential Outcomes. J Clin Med. 2024;13(12).

18. Goudie RJB, Turner RM, De Angelis D, Thomas A. MultiBUGS: A Parallel Implementation of the BUGS Modeling Framework for Faster Bayesian Inference. J Stat Softw. 2020;95(7):1-20.

19. Pearl J. Interpretation and Identification of Causal Mediation. Psychol Methods. 2014;19(4): 459-481.

20. Alegria M, Araneta MR, Rivers B. The National Advisory Council on Minority Health and Health Disparities Reflection. Am J Public Health. 2019;109:S14-S15.

21. Alvidrez J, Castille D, Laude-Sharp M, Rosario A, Tabor D. The National Institute on Minority Health and Health Disparities Research Framework. Am J Public Health. 2019;109:S16-S20.

22. Duran DG, Perez-Stable EJ. Novel Approaches to Advance Minority Health and Health Disparities Research. Am J Public Health. 2019;109:S8-S10.

23. Jeffries N, Zaslavsky AM, Roux AVD, et al. Methodological Approaches to Understanding Causes of Health Disparities. Am J Public Health. 2019;109:S28-S33.

24. Joseph KS, Lisonkova S, Boutin A, et al. Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance? Am J Obstet Gynecol. 2024; 230(4).

25. Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Rep. 2003;118(4):358-365.

26. Bazargan-Hejazi S, Ruiz M, Ullah S, et al. Racial and ethnic disparities in chronic health conditions among women with a history of gestational diabetes mellitus. Health Promot Perspe. 2021;11(1):54-59.