Socioeconomic, Racial, and Ethnic Disparities in Postpartum Readmissions in Patients with Preeclampsia a Multi-state Analysis, 2007–2014

• Published in: Journal of racial and ethnic health disparities Vol. 6; no. 4; pp. 806 - 820
• Main Authors: Wagner, Jennifer L., White, Robert S., Tangel, Virginia, Gupta, Soham, Pick, Jeremy S.
• Format: Journal Article
• Language: English
• Published: Cham Springer Science + Business Media 01.08.2019; Springer International Publishing; Springer Nature B.V
• Subjects: Analysis; Anemia; Cesarean section; Childbirth & labor; Comorbidity; Cultural differences; Diabetes; Eclampsia; Epidemiology; Ethnic differences; Ethnicity; Family income; Health care expenditures; Health care policy; Health insurance; High risk; Hospitalization; Hospitals; Hypertension; Inpatient care; Length of stay; Medicaid; Medical diagnosis; Medicare; Medicine; Medicine & Public Health; Obstetrics; ORIGINAL PAPERS; Patient Protection & Affordable Care Act 2010-US; Patients; Postal codes; Postpartum; Postpartum women; Pre-eclampsia; Preeclampsia; Pregnancy; Quality of Life Research; Race; Racial inequality; Readmission; Regression analysis; Risk; Social factors; Social Inequality; Social Structure; Socioeconomics; Statistical analysis; Statistical significance; Subgroups; Vagina; Variables; Womens health; New York; California; Florida; United States > US; Maryland; Readmission; Healthcare disparities; Socioeconomic disparities; Administrative database; Outcomes research; Preeclampsia
• ISSN: 2197-3792; 2196-8837
• DOI: 10.1007/s40615-019-00580-1

Purpose Childbirth is the most common reason for hospitalization for reproductive-aged women, with about 4 million annual deliveries nationally. Hypertension is the leading indication for postpartum readmission and therefore women with preeclampsia are at high risk for readmission. Social determinants of health are associated with increased readmission in postpartum patients; however, no study has specifically investigated readmissions in this higher risk group of patients. We sought to evaluate the effect of social determinants of health on postpartum readmissions in all postpartum patients and in a subgroup analysis of those with a diagnosis of preeclampsia. Methods We conducted a retrospective (2007–2014) analysis of all singleton deliveries in Florida, California, New York, and Maryland from the State Inpatient Databases, Healthcare Cost and Utilization Project. Primary outcomes were readmission at 30 days after delivery. Descriptive statistics were calculated, and multivariate regression analysis was used to estimate the adjusted odds ratio (OR) for readmissions. Subgroup analysis was performed on preeclampsia patients only. Statistical significance was evaluated at the < 0.05 alpha level. Results A total of 4,999,993 patients were included in our analysis. Among all postpartum patients and in subgroup analysis for preeclampsia patients only, readmission rates are higher for black patients, patients in the poorest quartile of median income, and patients with public insurance (Medicare or Medicaid). Conclusions The present study has shown that socioeconomic and racial/ethnic disparities exist in postpartum readmissions. These findings additionally exist among the already highest-risk preeclamptic patients. Future research should further elucidate this relationship and develop amelioration strategies.