(606) Do social determinants of health influence prescribing practices of low dose aspirin prophylaxis?

To evaluate social determinants of heath (SDH) and their effect on provider practices in prescribing low dose aspirin (LDA) for preeclampsia prophylaxis.

Study Design:

Retrospective cohort of patients who met SMFM criteria to recommend LDA prophylaxis that had live births at a single academic center between January - May 2021. Exclusion criteria: maternal age < 18 years and initiation of prenatal care in 3rd trimester. Patient characteristics, including SDH, criteria for LDA prophylaxis, timing of first prenatal visit and LDA initiation were collected. Statistical analysis was performed using Chi square, Fisher’s exact, and student t-tests (significance defined as p < 0.05) to compare different SDH and LDA prescribing practices.

Results:

During the study period, 55% (N=375/622) patients met inclusion criteria. Race and primary language did not affect appropriate prescribing practices of LDA (Table 1). When LDA prescribing rates were compared between different race categories (e.g., African American race or Non-white race), there was no difference. Most patients initiated prenatal care prior to 16 weeks (86.1%); 77.8% of those prescribed LDA were optimally initiated prior to 16 weeks. LDA prescription did not differ between those that initiated care before or after 16 weeks (31.9% vs. 26.9%, p = 0.473). The relationship between prenatal care initiation and LDA prescription did not differ across any SDH category. Government assisted insurance decreased the likelihood of correct LDA prescription by providers (p = 0.041). There was a 37% lower chance of being appropriately prescribed LDA prophylaxis for patients with government assisted insurance (OR 0.63, 95% CI 0.41-0.98).

Conclusion:

Only one social determinant of heath (SDH), government assisted insurance, was associated with lower prescription rate of LDA in patients at high risk of developing preeclampsia.