Introduction
There is limited evidence on how government spending is associated with maternal death.
This study investigates the associations between state and local government spending
on social and healthcare services and pregnancy-related mortality among the total,
non-Hispanic Black, Hispanic, and non-Hispanic White populations.
Methods
State-specific total population and race/ethnicity-specific 5-year (2015–2019) pregnancy-related
mortality ratios were estimated from annual natality and mortality files provided
by the National Center for Health Statistics. Data on state and local government spending
and population-level characteristics were obtained from U.S. Census Bureau surveys.
Generalized linear Poisson regression models with robust SEs were fitted to estimate
adjusted rate ratios and 95% CIs associated with proportions of total spending allocated
to social services and healthcare domains, adjusting for state-level covariates. All
analyses were completed in 2021–2022.
Results
State and local government spending on transportation was associated with 11% lower
overall pregnancy-related mortality (adjusted rate ratio=0.89, 95% CI=0.83, 0.96)
and 9%–12% lower pregnancy-related mortality among the racial/ethnic groups. Among
spending subdomains, expenditures on higher education, highways and roads, and parks
and recreation were associated with lower pregnancy-related mortality rates in the
total population (adjusted rate ratio=0.90, 95% CI=0.86, 0.94; adjusted rate ratio=0.87,
95% CI=0.81, 0.94; and adjusted rate ratio=0.68, 95% CI=0.49, 0.95, respectively).
These results were consistent among the racial/ethnic groups, but patterns of associations
with pregnancy-related mortality and other spending subdomains differed notably between
racial/ethnic groups.
Conclusions
Investing more in local- and state-targeted spending in social services may decrease
the risk for pregnancy-related mortality, particularly among Black women.
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Publication history
Published online: January 17, 2023
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
