Birth outcomes at the intersection of physical disability and race/ethnicity in Massachusetts, 1998-2021.

BACKGROUND: Women with physical disabilities face elevated risks of adverse birth outcomes, yet little is known about how these risks vary by race/ethnicity. OBJECTIVE: To examine birth outcomes at the intersection of physical disability and race/ethnicity in Massachusetts births, 1998-2021. METHODS: In this retrospective cohort study, we analyzed 1,503,233 singleton births using linked birth certificates and hospital discharges data. Modified Poisson regression estimated adjusted risk ratios for preterm birth and low birth weight. RESULTS: Non-Hispanic Black and Hispanic women with physical disabilities experienced highest risk for very preterm birth and very low birth weight. They faced 3.52 and 2.26 times the adjusted risks of very preterm birth (aRR = 3.52,95% CI:3.20-3.88, and aRR = 2.26; 95%CI: 2.05-2.50, respectively) and 4.04 and 2.47 times the adjusted risk of very low birth weight (aRR = 4.04, 95%CI:3.64-4.48; and aRR = 2.47; 95%CI:2.22-2.75), compared to White women without disabilities. Approximately 12-14% of the observed disparities in these outcomes were attributable to the interaction between physical disability and racial/ethnic identity. CONCLUSIONS: Women with both physical disabilities and minoritized racial/ethnic identities experience compounded risks for adverse birth outcomes, with risks exceeding the sum of those associated with each identity alone. There is need for adopting intersectional approaches to maternal healthcare that explicitly account for disability in the context of race and ethnicity.