Race, Medicaid Coverage, and Equity in Maternal Morbidity.
Race, Medicaid Coverage, and Equity in Maternal Morbidity.
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DOI：
10.1016/j.whi.2020.12.005
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Moore JE
中科院分区：
文献类型：
--
作者：
Brown CC;Adams CE;Moore JE
在美国，严重的孕产妇发病率(SMM)每年影响50,000例分娩，其中医疗补助覆盖的分娩比例是私人覆盖分娩的1.5倍左右。此外，在SMM中，非西班牙裔黑人妇女和西班牙裔妇女存在很大的种族不平等，其比例分别是白人妇女的2.1倍和1.4倍。这项研究旨在比较不同种族/民族和分娩保险类型的妇女在严重孕产妇发病率方面的差异。根据种族/族裔和保险状况的交集对SMM的比率进行量化，有助于说明多种形式的压迫和种族主义如何促成黑人妇女SMM中的重大不平等。利用医疗费用和利用项目的出院数据，全国住院患者样本(2016年和2017年)，我们进行了多变量Logistic模型，以评估不同主要支付者的妇女在孕产妇结局方面的公平性，总体上和按种族/民族分层。我们发现，严重的孕产妇发病率相当于每10,000次分娩中就有138.3例。在医疗补助覆盖的分娩中，非西班牙裔黑人、非西班牙裔亚洲人和西班牙裔女性相对于白人女性的SMM比率相对于所有支付者类型的分娩而言都较低。例如，在所有支付者中，黑人妇女的严重孕产妇发病率是白人妇女的2.17倍(221.3比102.1)；然而，在医疗补助覆盖的分娩中，黑人妇女的发病率是白人妇女的1.84倍(227.3比123.2)。尽管与医疗补助覆盖相关的风险增加(AOR：1.12；95%CI：1.07，1.16)，但在包括黑人女性在内的分层回归中，风险不再显著(AOR：1.06；95%CI：0.98，1.15)。我们的发现表明，与拥有私人保险的黑人女性相比，拥有医疗补助的黑人女性并不具有更高的SMM比率。国家和州的政策努力应继续侧重于解决结构性种族主义和造成不良产妇结果的其他社会经济驱动因素，包括阻碍医疗补助覆盖的妇女获得高质量护理的障碍。
Severe maternal morbidity (SMM) affects 50,000 deliveries in the US annually, with around 1.5 times the rates among Medicaid-covered relative to privately-covered deliveries. Furthermore, large racial inequities exist in SMM for Non-Hispanic Black women and Hispanic women with rates being 2.1 and 1.4 times higher than White women. This study aimed to compare differences in severe maternal morbidity among women of different races/ethnicities and delivery insurance types. Quantifying rates of SMM based on the intersection of race/ethnicity and insurance status can help elucidate how multiple forms of oppression and racism may contribute to the substantial inequities in SMM among Black women. Using hospital discharge data from the Healthcare Cost and Utilization Project, National Inpatient Sample (years 2016 and 2017), we conducted multivariate logistic models to evaluate equity in maternal outcomes among women with different primary payers, overall and stratified by race/ethnicity. We found a rate of severe maternal morbidity equal to 138.3 per 10,000 deliveries. Differences in the rate of SMM among non-Hispanic Black, non-Hispanic Asian, and Hispanic women relative to White women were lower among Medicaid-covered deliveries relative to deliveries of all payer types. For example, among all payers, Black women had 2.17 (221.3 vs 102.1 per 10,000) times the rate of severe maternal morbidity compared to White women; however, among Medicaid-covered deliveries, Black women had 1.84 (227.3 vs 123.2) times the rate. Despite increased risk associated with Medicaid coverage (aOR: 1.12; 95%CI: 1.07, 1.16), the risk was no longer significant in the stratified regression including Black women (aOR: 1.06; 95%CI: 0.98, 1.15). Our findings suggest that Black women with Medicaid do not have higher rates of SMM relative to Black women with private insurance. National and state policy efforts should continue to focus on addressing structural racism and other socioeconomic drivers of adverse maternal outcomes, including barriers to high-quality care among women with Medicaid coverage.
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影响因子：
5.6
作者：
Leonard, Stephanie A.;Main, Elliott K.;Carmichael, Suzan L.
通讯作者：
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2.3
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