Muchomba Felix M, Teitler Julien O, Reichman Nancy E
School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
School of Social Work, Columbia University, New York, New York, USA.
J Epidemiol Community Health. 2023 Oct 24. doi: 10.1136/jech-2023-220558.
Local government expenditures provide services and benefits that can affect health but the extent to which they are associated with narrowing or widening of racial/ethnic and socioeconomic disparities in health is unknown. We examined race/ethnicity-stratified and education-stratified associations between municipal social expenditures-those on housing, transportation, education, and other society-wide needs-and serious life-threatening maternal health conditions in a large US state.
In this cross-sectional study, we used individual birth records for 1 003 974 births in the state of New Jersey from 1 January 2008 to 31 December 2018 linked to individual maternal hospital discharge records and municipality-level characteristics for 564 municipalities. Severe maternal morbidity (SMM) was identified in the discharge records using a measure developed by the US Centers for Disease Control and Prevention. Associations between municipal-level social expenditures per capita and SMM were estimated using multilevel logistic models.
Residing in a municipality with higher social expenditures was associated with lower odds of SMM across all racial/ethnic groups and education levels. Overall, 1% higher annual social expenditures per capita was associated with 0.21% (95% CI -0.29 to -0.13) lower odds of SMM. The associations were greater for individuals with less than a high school education than for those in the other educational groups in both relative (lnOR -0.53; 95% CI -0.74 to -0.31) and absolute (β -0.013; 95% CI -0.019 to -0.008) terms.
Municipal-level spending on social services is associated with narrowing socioeconomic disparities in SMM. Narrowing racial/ethnic disparities in maternal health will likely require intervening beyond the provision of services to addressing historical and ongoing structural factors.
地方政府支出提供的服务和福利可能会影响健康，但这些支出与健康方面种族/族裔和社会经济差距的缩小或扩大之间的关联程度尚不清楚。我们在美国一个大州研究了市政社会支出（用于住房、交通、教育及其他社会需求方面的支出）与严重危及生命的孕产妇健康状况之间按种族/族裔分层和按教育程度分层的关联。
在这项横断面研究中，我们使用了新泽西州2008年1月1日至2018年12月31日期间1,003,974例分娩的个体出生记录，并将其与个体孕产妇医院出院记录以及564个市镇的市镇层面特征相链接。使用美国疾病控制与预防中心制定的一项指标在出院记录中识别严重孕产妇发病率（SMM）。使用多水平逻辑模型估计人均市政社会支出与SMM之间的关联。
在所有种族/族裔群体和教育水平中，居住在社会支出较高的市镇与SMM发生率较低相关。总体而言，人均年度社会支出每增加1%，SMM发生率降低0.21%（95%CI -0.29至-0.13）。在相对（对数比值比-0.53；95%CI -0.74至-0.31）和绝对（β -0.013；95%CI -0.019至-0.008）方面，受教育程度低于高中的个体的关联程度大于其他教育群体的个体。
市政层面在社会服务上的支出与缩小SMM方面的社会经济差距相关。缩小孕产妇健康方面的种族/族裔差距可能需要在提供服务之外进行干预，以解决历史和当前的结构性因素。
