# Multilevel Determinants of Racial and Ethnic Disparities in Maternal Morbidity and Mortality in the Context of COVID-19 Pandemic

> **NIH NIH R01** · UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA · 2021 · $886,186

## Abstract

Abstract
Annually in the U.S., nearly 60,000 women experience severe maternal morbidity and mortality (SMMM) with
substantial health disparities by race/ethnicity, even prior to the COVID-19 pandemic. The unprecedented
COVID-19 pandemic has hit communities of color the hardest. Non-Hispanic Black and Hispanic women who
are pregnant appear to have disproportionate SARS-CoV-2 infection and death rates. Questions regarding the
impact of the COVID-19 pandemic on racial disparities in SMMM and the dynamics and interactions of
multilevel determinants such as broader social contexts of SMMM remain unanswered. The overarching goal
of this study is to investigate racial/ethnic disparities in maternal morbidity and mortality (MMM), the
contributing roles and mediating pathways of social contexts (e.g., residential segregation, racial
discrimination in poverty, education, unemployment, and home ownership), and their long-standing health
consequences postpartum. We will achieve our goal by studying the distributions of COVID-19 cases and
multilevel determinants of maternal health in South Carolina (SC), a state with persistent racial disparities in
SMMM within historical systemic Southern contexts, and in the U.S. We will build upon our existing statewide
SC COVID-19 Cohort (S3C) by creating a pregnancy cohort that will link COVID-19 testing data, electronic
health records (EHR), and birth certificate data for all births in SC in 2019-2020. To ensure the generalizability
of our findings, we will confirm them using EHR data from the ongoing National COVID Cohort Collaborative
(N3C). Nationwide social context databases and time-varying COVID-19 severity and social distancing policies
will be added to S3C and N3c data. We will use the socio-ecological framework and employ a concurrent
triangulation, mixed methods study design to achieve three specific aims: 1) to examine the impacts of the
COVID-19 pandemic on racial/ethnic disparities in MMM; 2) to examine and explore how the key features of
social contexts have contributed to the widening of racial/ethnic disparities in MMM during the pandemic
(Aim 2a) and identify distinct mediating pathways through maternity care and mental health (Aim 2b); and 3)
to examine the role of social contextual factors and identify protective factors for racial/ethnic disparities in
pregnancy-related, long-standing morbidities using machine learning algorithms. For Aim 2b, a convergent
parallel design will be used, which includes a quantitative analysis of data from SC PRAMS and qualitative
interviews of postpartum women (20 Black, 20 Hispanics) and 10 maternal care providers. Our experienced
team is well positioned to investigate the complexity of racial disparities in MMM during the COVID-19
pandemic, while considering historical structural racism in a racially, socioeconomically, and geographically
diverse population of pregnant women. A rigorous examination of social contexts on racial/ethnic disparities in
MMM and mental heal...

## Key facts

- **NIH application ID:** 10392607
- **Project number:** 3R01AI127203-05S2
- **Recipient organization:** UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
- **Principal Investigator:** Xiaoming Li
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $886,186
- **Award type:** 3
- **Project period:** 2021-09-07 → 2023-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10392607

## Citation

> US National Institutes of Health, RePORTER application 10392607, Multilevel Determinants of Racial and Ethnic Disparities in Maternal Morbidity and Mortality in the Context of COVID-19 Pandemic (3R01AI127203-05S2). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10392607. Licensed CC0.

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