# Hospital Costs of Severe Maternal Morbidity Hospitalizations in the United States from 2014 to 2019: A Nationwide Cross-Sectional Study

## TL;DR

This study analyzed hospital costs for deliveries with severe maternal morbidity in the U.S. from 2014 to 2019, finding rising costs and disparities by race and hospital type.

## Contribution

The study provides new insights into the increasing costs of severe maternal morbidity hospitalizations and identifies disparities linked to race, delivery methods, and hospital characteristics.

## Key findings

- Hospital costs for deliveries with severe maternal morbidity increased over time, peaking in 2019.
- Racial disparities exist, with non-Hispanic White patients having lower costs compared to other races.
- Cesarean deliveries and urban teaching hospitals had higher SMM-related costs.

## Abstract

The objective of this study was to estimate the average hospitalization cost (AHC) for deliveries affected by severe maternal morbidity (SMM) and analyze trends from 2014 to 2019. The study also aimed to explore cost stratification based on patient, delivery, and hospital characteristics.

Using the National Inpatient Sample dataset, all delivery hospitalizations from 2014 to 2019 were identified. Deliveries affected by SMM were determined based on the Centers for Disease Control definition. Deliveries were categorized into three groups: no SMM (nSMM), any SMM (aSMM), and SMM excluding cases with blood transfusion as the only indicator (SMMeBTo). A regression model accounting for survey design and adjusting for variables including age, race/ethnicity, primary payer, income, delivery method, hospital location/teaching status, and hospital region was used to test the trends in incidence. Hospital charges were adjusted using cost-to-charge ratios and presented in 2022 U.S. dollars ($). A regression model adjusting for the same variables was used to assess costs.

From 2014 to 2019, 4,444,957 deliveries were identified, with a weighted estimate of 22,224,775. The rates of aSMM and SMMeBTo were 1.9 and 0.7%, respectively. AHC was $5,218 (95% confidence intervals [CI]: $5,200–5,235) for nSMM, $11,101 (95% CI: $11,038–11,165) for aSMM, and $11,541 (95% CI: $114,330–11,650) for SMMeBTo. Hospitalization costs across all SMM categories rose annually from 2014 to 2017, decreased in 2018, and peaked in 2019. All races had significantly higher costs than non-Hispanic Whites across all SMM categories. SMM costs were higher for cesarean deliveries. The highest cost was in deliveries involving a temporary tracheostomy. Urban teaching hospitals and those in the Northeast had the highest SMM costs.

Deliveries affected by SMM incur significantly higher costs, with these costs increasing over time. Understanding disparities across patient factors, delivery methods, and hospital characteristics can inform interventions aimed at addressing inequities.

Costs of SMM hospitalizations are rising, even after adjusting for inflation.

The escalating cost burden is disproportionately shouldered by different racial groups.

Factors in delivery and hospital settings contribute to the variation in cost.