TY - JOUR
T1 - Does Universal Coverage Mitigate Racial Disparities in Potentially Avoidable Maternal Complications?
AU - Ranjit, Anju
AU - Andriotti, Tomas
AU - Madsen, Cathaleen
AU - Koehlmoos, Tracey
AU - Staat, Barton
AU - Witkop, Catherine
AU - Little, Sarah E.
AU - Robinson, Julian
N1 - Funding Information:
The content of this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the Uniformed Services University of the Health Sciences, the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense, or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the US government. The Center for Surgery and Public Health and the Uniformed Services University of Health Sciences are funded by the Defense Health Agency, Award (#HU0001-11-1-0023) to provide salary support for protected research efforts involving analysis and study of military TRICARE data. The following investigators receive corresponding partial salary support: T.A.
Publisher Copyright:
© 2021 Georg Thieme Verlag. All rights reserved.
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Objective Potentially avoidable maternity complications (PAMCs) have been validated as an indicator of access to quality prenatal care. African-American mothers have exhibited a higher incidence of PAMCs, which has been attributed to unequal health coverage. The objective of this study was to assess if racial disparities in the incidence of PAMCs exist in a universally insured population. Study Design PAMCs in each racial group were compared relative to White mothers using multivariate logistic regression. Stratified subanalyses assessed for adjusted differences in the odds of PAMCs for each racial group within direct versus purchased care. Results A total of 675,553 deliveries were included. Among them, 428,320 (63%) mothers were White, 112,170 (17%) African-American, 37,151 (6%) Asian/Pacific Islanders, and 97,912 (15%) others. African-American women (adjusted odds ratio [aOR]: 1.05, 95% CI: 1.02-1.08) were more likely to have PAMCs compared with White women, and Asian women (aOR: 0.92, 95% CI: 0.89-0.95) were significantly less likely to have PAMCs compared with White women. On stratified analysis according to the system of care, equal odds of PAMCs among African-American women compared with White women were realized within direct care (aOR: 1.03, 95% CI: 1.00-1.07), whereas slightly higher odds among African-American persisted in purchased (aOR: 1.05, 95% CI: 1.01-1.10). Conclusion Higher occurrence of PAMCs among minority women sponsored by a universal health coverage was mitigated compared with White women. Protocol-based care as in the direct care system may help overcome health disparities.
AB - Objective Potentially avoidable maternity complications (PAMCs) have been validated as an indicator of access to quality prenatal care. African-American mothers have exhibited a higher incidence of PAMCs, which has been attributed to unequal health coverage. The objective of this study was to assess if racial disparities in the incidence of PAMCs exist in a universally insured population. Study Design PAMCs in each racial group were compared relative to White mothers using multivariate logistic regression. Stratified subanalyses assessed for adjusted differences in the odds of PAMCs for each racial group within direct versus purchased care. Results A total of 675,553 deliveries were included. Among them, 428,320 (63%) mothers were White, 112,170 (17%) African-American, 37,151 (6%) Asian/Pacific Islanders, and 97,912 (15%) others. African-American women (adjusted odds ratio [aOR]: 1.05, 95% CI: 1.02-1.08) were more likely to have PAMCs compared with White women, and Asian women (aOR: 0.92, 95% CI: 0.89-0.95) were significantly less likely to have PAMCs compared with White women. On stratified analysis according to the system of care, equal odds of PAMCs among African-American women compared with White women were realized within direct care (aOR: 1.03, 95% CI: 1.00-1.07), whereas slightly higher odds among African-American persisted in purchased (aOR: 1.05, 95% CI: 1.01-1.10). Conclusion Higher occurrence of PAMCs among minority women sponsored by a universal health coverage was mitigated compared with White women. Protocol-based care as in the direct care system may help overcome health disparities.
KW - claims data
KW - potentially avoidable maternal complications
KW - racial disparities
KW - TRICARE
KW - universal health coverage
UR - http://www.scopus.com/inward/record.url?scp=85111788907&partnerID=8YFLogxK
U2 - 10.1055/s-0040-1701195
DO - 10.1055/s-0040-1701195
M3 - Article
C2 - 31986540
AN - SCOPUS:85111788907
SN - 0735-1631
VL - 38
SP - 848
EP - 856
JO - American Journal of Perinatology
JF - American Journal of Perinatology
IS - 8
ER -