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Slaughter-Acey J, Behrens K, Claussen AM, et al. Social and Structural Determinants of Maternal Morbidity and Mortality: An Evidence Map [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2023 Dec. (Comparative Effectiveness Review, No. 264.)

Cover of Social and Structural Determinants of Maternal Morbidity and Mortality: An Evidence Map

Social and Structural Determinants of Maternal Morbidity and Mortality: An Evidence Map [Internet].

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Chapter 3Search Results

Our search identified 8,378 unique publications for screening. Based on inclusion criteria, we identified 118 eligible studies. We list all studies excluded at full text appraisal, by exclusion category, in Appendix B. Exclusions captured under “other reasons” are varied and overlapping, so often not easily placed into a more singular category. For example, an “other reasons” exclude might have been for both study quality and a challenging interpretation on whether the risk factors were interpersonal in nature. See Figure 3.1 for details of the screening process.

Figure 3.1 is a flowchart of the results of the search and screening process for the review. The top row of the flow chart is titled "searching" and contains two boxes, on the left is "records identified through database searching (n=9444)" and on the right is "records identified through other sources (n=0)". A line connects these two boxes to arrow pointing below to the "screening" section containing a breakdown of the records which contains later stages in the screening process. At the top is "records after duplicates removed (n=8378)" with arrow pointing to the right to "duplicates (n=1066)", on the next row is "records after title/abstract screening (n=1622)" with arrow pointing to the right to "excluded at title/abstract (n=6756)." On the next row is "articles retrieved at full text (n=1622)" with arrow pointing to the right to "unretrievable full texts not found (n=0)". On the next row is "articles after full text screening (n=574)" with arrow pointing to the right to excluded full text with reasons (n=1048); exluded on: population (n=44), intervention/exposure (n=178), comparator (n=0), outcome (n=352), study design (n=152), non-US (n=11), publication type (n=84), other reasons (n-365), duplicates (n=14). There is an arrow pointdown from "articles after full text screening (n=574)" to the critical appraisal and synthesis section. There is box showing "articles included after critical full text appraisal (n=574)" with arrow pointing to the right to "excluded from appraisal with reasons (n=456); population (n=18), exposure (n=146), comparison (n=0), outcome (n=107), study design (n=86), timing (n=15), other (n=93), duplicates (n=5). At the bottom is a box stating "studies included in narrative synthesis (n=118)"

Figure 3.1

Literature flow diagram. Abbreviations: n = number

The 118 included studies were published between 2000 and 2022. The studies contained 221 specifically named exposures or factors of interest. While many of these exposures or factors of interest are comparable or overlap, studies used various language and operational definitions for them. Using the named exposures, we categorized the studies into 11 broad exposure domains based on the main social-structural determinant of health. Table 3.1 presents the number of included studies by Key Question and exposure domain. The exposure domains are illustrated by example named exposure or factor of interest. Some studies used data that focused on particular populations, such as Black, Hispanic, or military veterans. As shown in Table 3.1, these populations represent only a subset of the many potential populations of interest.

Table 3.1. Identified eligible studies by major exposure domain.

Table 3.1

Identified eligible studies by major exposure domain.

Table 3.2 presents the number of included studies by Key Qquestion, outcome domain, and special populations for those outcomes. The outcome domains are illustrated by examples of named outcome variables from included studies.

Table 3.2. Identified eligible studies by outcome domain.

Table 3.2

Identified eligible studies by outcome domain.

As shown in Table 3.3, included data varied widely in sample size and source. Sample sizes ranged from as small as 16 women whose deaths were examined for potential preventability, to several million pregnant or birthing people. Categories of data sources are provided in Table 3.3. Nine studies used Pregnancy Risk Assessment Monitoring System data.

Table 3.3. Data sources, number of studies, and sample size ranges.

Table 3.3

Data sources, number of studies, and sample size ranges.

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