Disparities in Access to Uterine Artery Embolization for Patients with Severe Postpartum Hemorrhage

Purpose: Maternal morbidity and mortality rates in the U.S. are notably high, with postpartum hemorrhage (PPH) as a leading cause. This study aims to assess racial, socioeconomic, and geographic disparities in access to uterine artery embolization (UAE), a minimally invasive and life-saving treatment for severe PPH.

Materials and Methods: A retrospective analysis was conducted using data from the National Inpatient Sample (2016–2021) to identify adult inpatient admissions with severe PPH, defined by the need for interventions such as transfusion, UAE, and/or hysterectomy. Patients were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis and procedural coding system (PCS). Key patient demographics such as gender, age, race, and income quartile along with hospital characteristics such as region, rural/urban status, and size were recorded. Logistic regression models were employed to calculate the odds of receiving UAE, adjusting for demographic variables and major maternal and delivery risk factors.

Results: Out of 128,970 patients with severe PPH from 2016 to 2021, 7,975 (6.2%) underwent UAE, while 11,595 (9.0%) were treated with hysterectomy. The proportion of patients receiving UAE increased slightly from 5.7% in 2016 to 6.6% in 2021, though this change was not statistically significant (p = 0.088). Compared to other patients with severe PPH, those who received UAE were older (median age 33 vs. 30 years, p < 0.001), more likely to have undergone a cesarean section (53.3% vs. 46.6%, p < 0.001), and more likely to have placenta accreta (9.3% vs. 5.6%). After adjusting for demographic variables and maternal/delivery risk factors, Hispanic patients were found to be less likely to receive UAE compared to White patients (OR 0.83 [95% CI 0.71–0.98], p = 0.024). Additionally, higher-income patients were more likely to receive UAE than those in lower-income brackets (OR 1.58 [95% CI 1.31–1.89], p = 0.024). Geographic disparities were also evident, with patients in the Midwest (OR 1.39 [95% CI 1.12–1.72], p = 0.003) and West (OR 1.39 [95% CI 1.12–1.72], p < 0.001) more likely to receive UAE than those in the Northeast.

Conclusion: This study highlights significant racial, socioeconomic, and geographic disparities in access to UAE for patients with severe PPH. These findings underscore the need for targeted interventions to improve equitable access to UAE across different patient populations.