Rural and Urban Differences in Insurance Coverage at Prepregnancy, Birth, and Postpartum.
Rural and Urban Differences in Insurance Coverage at Prepregnancy, Birth, and Postpartum.
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DOI：
10.1097/aog.0000000000005081
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发表时间：
2023-03-01
影响因子：
7.2
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中科院分区：
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与城市居民相比，农村居民在孕前、分娩和产后以及在每个时期持续经历更大的不保险几率。衡量美国城乡居民在孕前、分娩和产后的保险覆盖率，以及这些时期的保险覆盖连续性。我们对来自43个州和两个司法管辖区的154，992名产后个体的调查数据进行了汇总的横断面分析，这些数据参与了2016-2019年PRAMS（妊娠风险评估监测系统）。我们计算了三个时期（怀孕前，出生和产后）的保险覆盖率（医疗补助，商业或无保险）的未经调整的估计值，以及美国农村和城市居民在这些时期的保险连续性。我们进行了亚组分析，比较农村和城市居民的社会人口学和临床特征的保险率。我们使用逻辑回归模型为每次比较生成调整后的比值比（aOR）。农村居民经历了更大的几率，在每个时期和持续的保险在所有三个时期，与他们的城市同行。农村居民孕前未参保率高于城市居民（15.4% vs 12.1%; aOR 1.19，95% CI 1.11-1.28），出生时（4.6% vs 2.8%; aOR 1.60，95% CI 1.41-1.82）和产后（12.7% vs 9.8%，aOR 1.27，95% CI 1.17-1.38）。在每一个时期，农村居民谁是非西班牙裔白色，已婚，并打算怀孕经历了更大的调整后的几率与城市相比，不保险。在医疗补助扩展州和非扩展州，以及教育和收入水平不同的州，不保险的城乡差异仍然存在。西班牙裔、英语国家和土著人在怀孕前和出生时都经历了围产期覆盖率在农村的不平等。在所调查的43个州中，与城市居民相比，围产期无保险对农村居民的影响不成比例。不同的保险覆盖面可能对解决农村和城市在孕产妇保健和孕产妇健康方面的不平等问题产生重要影响。
Rural residents, compared with urban residents, experience greater odds of uninsurance at prepregnancy, birth, and postpartum and continuously across each period. To measure insurance coverage at prepregnancy, birth, and postpartum, and insurance coverage continuity across these periods among rural and urban U.S. residents. We performed a pooled, cross-sectional analysis of survey data from 154,992 postpartum individuals in 43 states and two jurisdictions that participated in the 2016–2019 PRAMS (Pregnancy Risk Assessment Monitoring System). We calculated unadjusted estimates of insurance coverage (Medicaid, commercial, or uninsured) during three periods (prepregnancy, birth, and postpartum), as well as insurance continuity across these periods among rural and urban U.S. residents. We conducted subgroup analyses to compare uninsurance rates among rural and urban residents by sociodemographic and clinical characteristics. We used logistic regression models to generate adjusted odds ratios (aORs) for each comparison. Rural residents experienced greater odds of uninsurance in each period and continuous uninsurance across all three periods, compared with their urban counterparts. Uninsurance was higher among rural residents compared with urban residents during prepregnancy (15.4% vs 12.1%; aOR 1.19, 95% CI 1.11–1.28], at birth (4.6% vs 2.8%; aOR 1.60, 95% CI 1.41–1.82), and postpartum (12.7% vs 9.8%, aOR 1.27, 95% CI 1.17–1.38]. In each period, rural residents who were non-Hispanic White, married, and with intended pregnancies experienced greater adjusted odds of uninsurance compared with their urban counterparts. Rural–urban differences in uninsurance persisted across both Medicaid expansion and non–expansion states, and among those with varying levels of education and income. Rural inequities in perinatal coverage were experienced by Hispanic, English-speaking, and Indigenous individuals during prepregnancy and at birth. Perinatal uninsurance disproportionately affects rural residents, compared with urban residents, in the 43 states examined. Differential insurance coverage may have important implications for addressing rural–urban inequities in maternity care access and maternal health.