Racial disparities in maternal outcomes among pregnant patients with cancer: A National Inpatient Sample analysis.

Abstract

e23244 Background: Pregnancy-associated cancer affects approximately 1 in 1,000 pregnancies. We conducted a national analysis to characterize outcomes and disparities among pregnant patients with cancer. Methods: Using the National Inpatient Sample (2019-2022), we identified pregnancy-related hospitalizations (ICD-10: O00-O9A, Z33-Z34) among reproductive-age women (15-54 years) with concurrent cancer diagnoses (C00-C96). Primary outcomes were in-hospital maternal mortality and severe maternal morbidity (SMM), defined using CDC criteria. Multivariable logistic regression estimated adjusted odds ratios (aOR) for racial/ethnic disparities, controlling for age, insurance, hospital type, cancer type, and metastatic status. Results: Among 15.2 million pregnancy hospitalizations, 13,305 (0.09%; 8.7 per 10,000) involved a cancer diagnosis. The most common malignancies were leukemia (20.2%), breast cancer (16.6%), and lymphoma (13.2%). Overall maternal mortality was 7.5 per 1,000, and SMM occurred in 24.8%. Significant racial disparities emerged: Black women experienced 2.5-fold higher crude mortality (14.1 vs 5.6 per 1,000) and 41% higher SMM rates (32.6% vs 23.1%) compared to White women. After full adjustment, Black race had mortality of (aOR 1.88, 95% CI 1.14-3.11, p = 0.013) and SMM (aOR 1.63, 95% CI 1.46-1.83, p < 0.0001). Specific SMM indicators demonstrated profound disparities: Black women had 4.2-fold higher rates of mechanical ventilation, 3.3-fold higher acute kidney injury, 2.8-fold higher DIC, and 2.7-fold higher VTE compared to White women. Metastatic disease (aOR 5.80, 95% CI 3.42-9.85) and leukemia (aOR 2.42, 95% CI 1.31-4.48) were additional independent mortality predictors. Conclusions: Black pregnant patients with cancer face nearly twice the mortality risk of White patients, with disparities persisting after adjustment for clinical and socioeconomic factors. These findings support the need for targeted interventions, enhanced multidisciplinary care coordination, and equity-focused quality improvement initiatives for pregnant patients with cancer, with particular attention to Black maternal health. Racial disparities in maternal outcomes among pregnant patients with cancer. Outcome Overall White Black Hispanic Asian/PI aOR (Black vs White) 95% CI P-value Key Finding Cohort (N) 13,305 7,165 (53.9%) 2,130 (16.0%) 2,435 (18.3%) 590 (4.4%) — — — Rate: 8.7/10,000 pregnancies MATERNAL MORTALITY Per 1,000 admissions 7.5 5.6 14.1 6.2 8.5 1.88 1.14-3.11 0.013 Black 2.5× higher mortality SEVERE MATERNAL MORBIDITY SMM Rate (%) 24.8 23.1 32.6 23.2 26.3 1.63 1.46-1.83 <0.0001 Black 63% higher SMM SMM INDICATORS (Black vs White) Mechanical Ventilation (%) — 1.4 5.9 — — 4.2× — — Most striking disparity AKI / Blood Transfusion (%) — 2.2 / 4.1 7.0 / 9.2 — — 3.3× / 2.2× — — Significant organ dysfunction Mean LOS (days) 5.0 4.4 6.9 5.2 4.8 — — — Black 57% longer LOS