Reducing Cardiovascular Maternal Mortality by Extending Medicaid for Postpartum Women.
Reducing Cardiovascular Maternal Mortality by Extending Medicaid for Postpartum Women.
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DOI：
10.1161/jaha.121.022040
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发表时间：
2021-08-03
影响因子：
5.4
通讯作者：
Lindley KJ
中科院分区：
文献类型：
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作者：
Luther JP;Johnson DY;Joynt Maddox KE;Lindley KJ
在过去的30年里，美国的孕产妇死亡率一直在上升，而同期所有其他高收入国家的孕产妇死亡率都在下降。心血管疾病占产妇死亡的四分之一以上，三分之二的死亡发生在产后。在孕产妇发病率和死亡率较高的妇女中，也发现了显著的保健差距，黑人妇女的死亡风险是白色妇女的3至4倍，农村妇女的心血管疾病发病率和孕产妇发病率风险更高。然而，许多孕产妇死亡已被证明是可以预防的，改善获得护理的机会可能是解决孕产妇心血管死亡问题的一个关键解决方案。医疗补助目前为美国近一半的分娩提供资金，并被授权为收入高达联邦贫困线138%的妇女提供产后60天的保险。在没有扩大保险范围的州，新妈妈在60天后就没有保险了。医疗补助的扩大已被证明可以降低孕产妇死亡率，特别是有利于种族和少数民族，可能是通过减少保险流失，改善产后护理，改善解释性护理。然而，即使在医疗补助扩大的州，也存在显著的护理差距。改善这些高危人群获得护理的另一项拟议干预措施是在分娩后将医疗补助覆盖范围延长1年，这将为医疗补助未扩大州的妇女提供最大利益，但也改善了医疗补助扩大州妇女的护理。
Maternal mortality has been increasing in the United States over the past 3 decades, while decreasing in all other high‐income countries during the same period. Cardiovascular conditions account for over one fourth of maternal deaths, with two thirds of deaths occurring in the postpartum period. There are also significant healthcare disparities that have been identified in women experiencing maternal morbidity and mortality, with Black women at 3 to 4 times the risk of death as their White counterparts and women in rural areas at heightened risk for cardiovascular morbidity and maternal morbidity. However, many maternal deaths have been shown to be preventable, and improving access to care may be a key solution to addressing maternal cardiovascular mortality. Medicaid currently finances almost half of all births in the United States and is mandated to provide coverage for women with incomes up to 138% of the federal poverty level, for up to 60 days postpartum. In states that have not expanded coverage, new mothers become uninsured after 60 days. Medicaid expansion has been shown to reduce maternal mortality, particularly benefiting racial and ethnic minorities, likely through reduced insurance churn, improved postpartum access to care, and improved interpregnancy care. However, even among states with Medicaid expansion, significant care gaps exist. An additional proposed intervention to improve access to care in these high‐risk populations is extension of Medicaid coverage for 1 year after delivery, which would provide the most benefit to women in Medicaid nonexpanded states, but also improve care to women in Medicaid expanded states.