Health Equity/Community Health
Poster Session 2
Sbaa Syeda, MD
Fellow
Columbia University Medical Center
New York, NY, United States
Uma M. Reddy, MD, MPH
Professor and Vice Chair of Research, Department of Obstetrics and Gynecology
Columbia University
New York, New York, United States
Alexander M. Friedman, MD
Columbia University
New York, NY, United States
Timothy Wen, MD,MPH (he/him/his)
Clinical Fellow
University of California, San Francisco (UCSF)
San Francisco, CA, United States
Non-transfusion severe maternal morbidity (ntSMM) and maternal mortality are key indicators of population health with a disparate burden on certain socioeconomic groups. We sought to compare temporal trends in ntSMM and mortality among births by payer status.
Study Design:
This cross-sectional study analyzed data from the 2000-2020 Nationwide Inpatient Sample. Mortality and ntSMM (per Centers for Disease Control and Prevention criteria) trends were stratified by payer status (Medicaid versus commercial) and analyzed using joinpoint regression estimating the average annual percent change (AAPC) with 95% confidence intervals (CI). Logistic regression models were performed to estimate adjusted odds ratios (aORs) for maternal mortality and ntSMM accounting for demographic, hospital, and clinical factors.
Results:
Of 80.2 million births, 41.3% and 52.1% were Medicaid and commercially insured births, respectively. The rate of ntSMM increased steadily from 56 to 93 per 100,000 Medicaid births (AAPC 2.6%, 95% CI 1.9%, 3.4%). Among the commercially insured, ntSMM rates significantly increased from 51 to 77 per 100,000 births in 2000-2013 (AAPC 3.3%, 95% CI 2.4%, 5.0%), but later significantly decreased from 77 to 72 per 100,000 births in 2013-2020 (AAPC -2.3%, 95% CI -6.7%, -0.1%). Mortality did not significantly change over this time (Figure). Specifically, maternal deaths among individuals with Medicaid did not increase between 2000-2020 (AAPC 2.7%, 95% CI -0.5%, 6.2%) or between 2014-2020 (AAPC 12.1%, 95% CI -0.2%, 48.8%). In adjusted analysis, Medicaid births had 14% (aOR 1.14, 95% CI 1.12, 1.16) and 75% (aOR 1.75, 95% CI 1.48, 2.08) higher odds of ntSMM and mortality, respectively, compared to commercially insured births.
Conclusion:
Disparities in ntSMM and maternal mortality persist based on socioeconomic status. While ntSMM rates have decreased among commercially insured births, it has continued to rise in those with Medicaid. Medicaid insured individuals are significantly more likely to incur ntSMM and die during delivery hospitalization compared to those with commercial insurance.