Disparities in Maternal Mortality, Metropolitan Status, and Socioeconomic Conditions in U.S. Counties

This dissertation explores the geographic differences in maternal mortality ratio in counties in the United States (US). Specifically, the dissertation examines how maternal sociodemographic characteristics and residential socioeconomic conditions such as metropolitan status, residential segregation, social deprivation, income inequality, and obstetric health care availability affect the risk of maternal deaths in US counties. Generalized Linear Bayesian Models (GLBM), including hierarchical Bayesian models, were used to estimate the association between maternal sociodemographic characteristics and residential socioeconomic conditions and maternal mortality risk ratios in US counties. A major conclusion is that non-metropolitan counties have a higher maternal mortality ratio compared to metropolitan counties in the US, even after controlling for maternal sociodemographic characteristics, residential socioeconomic conditions, and health care availability. Particularly, accounting for socioeconomic conditions, including healthcare access, maternal mortality risk ratios are notably elevated in Southern non-metropolitan counties in the United States compared to their counterparts in other regions, except for non-metropolitan counties in the Midwest region. Furthermore, the risk of maternal death during and after pregnancy for older women (aged 30 and above) is higher in non-metropolitan counties compared to urban counties. Moreover, the Isolation of the black population increases the maternal mortality ratio in US counties, controlling for degrees of rurality, social deprivation, and income inequality. Finally, the interaction between residents of different socioeconomic statuses (poor and non-poor) in a county has a protective effect on the maternal mortality ratio.