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

J Racial Ethn Health Disparities. 2019 Aug;6(4):806-820. doi: 10.1007/s40615-019-00580-1. Epub 2019 Mar 18.

Abstract

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.

Keywords: Administrative database; Healthcare disparities; Outcomes research; Preeclampsia; Readmission; Socioeconomic disparities.

MeSH terms

  • Adolescent
  • Adult
  • African Americans / statistics & numerical data
  • Comorbidity
  • Continental Population Groups / statistics & numerical data*
  • Delivery, Obstetric / methods
  • Ethnic Groups / statistics & numerical data*
  • Female
  • Healthcare Disparities / ethnology
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Medical Assistance
  • Patient Readmission / statistics & numerical data*
  • Postpartum Period
  • Poverty
  • Pre-Eclampsia / ethnology*
  • Pregnancy
  • Pregnancy Complications / ethnology
  • Retrospective Studies
  • Social Determinants of Health / ethnology*
  • Socioeconomic Factors
  • United States
  • Young Adult