Trends in the Frequency of Severe Maternal Morbidity Among American Indian and Alaska Native Individuals at Two Major Hospitals in the East Valley, Arizona.

Authors

Abigail J Nielsen, Noor Farghaly, Laila Younes, Jane Ahn, Abdul Waheed, Erum Azhar

Published in

Cureus. Volume 18. Issue 9. Pages e116421. Epub Sep 17, 2026.

Abstract

Introduction The United States continues to see rising rates of maternal mortality (MM) and severe maternal morbidity (SMM), with American Indian and Alaska Native (AI/AN) individuals facing particularly high risk. Arizona shows marked maternal health disparities, yet localized data on AI/AN maternal health remains limited. This study set out to examine trends in SMM among AI/AN birthing individuals in the East Valley of Arizona. By focusing on hospital-level data, the study aimed to address critical gaps in region-specific AI/AN maternal health data that are often underrepresented in statewide or national analyses. Understanding local trends is essential for identifying actionable disparities and shaping targeted interventions. Methods A retrospective cross-sectional analysis was carried out using de-identified data from Chandler Regional Medical Center (CRMC) and Mercy Gilbert Medical Center (MGMC) in the East Valley of Arizona, facilities that are part of the largest integrated healthcare system, between January 2020 and December 2025. Shewhart control charts were used to establish baseline SMM rates and identify racial disparities. The study population consisted of eligible delivery hospitalizations at CRMC and MGMC during the study period. Delivery hospitalizations were stratified by documented race and ethnicity, and SMM cases were identified within each racial and ethnic group. AI/AN birthing individuals served as the primary population of interest. Data were analyzed using JMP Pro 19 software. Linear regression, subgroup race and ethnicity analyses, and Statistical Process Control (SPC) charts were used to assess disparities and temporal trends. Analyses were designed to detect both between-group differences and within-group changes over time, with particular attention to identifying statistically significant trends in SMM rates. Results AI/AN birthing individuals recorded the highest cumulative SMM rate across all racial and ethnic groups analyzed at both hospitals (4.12%; 64 SMM cases among 1,554 deliveries). AI/AN individuals saw a more than fivefold increase in SMM rates, from 1.13% in 2020 to 6.17% in 2025, and were the only racial or ethnic group to show a statistically significant increase over time (0.848 percentage points per year; R² = 0.6866, p = 0.0415). Conclusions These findings highlight a growing maternal health disparity among AI/AN populations in the East Valley. Future analyses will include multivariate and subgroup comorbidity analyses, including age, prenatal care, comorbid conditions, and socioeconomic indicators. Local, community-informed interventions are urgently needed to address these worsening trends and improve maternal outcomes. Hospital-based, culturally responsive data analysis could serve as a model for identifying and addressing maternal health inequities in other regions with significant AI/AN populations.

PMID:
42893270
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

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