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Am J Perinatol 2022; 39(02): 125-133
DOI: 10.1055/s-0041-1739310
SMFM Fellowship Series Article

Disparities in Obstetric Readmissions: A Multistate Analysis, 2007–2014

Kathy C. Matthews 
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
,
Virginia E. Tangel
2   Department of Anesthesiology, Center for Perioperative Outcomes, Weill Cornell Medicine, New York, New York
,
Sharon E. Abramovitz
2   Department of Anesthesiology, Center for Perioperative Outcomes, Weill Cornell Medicine, New York, New York
,
Laura E. Riley
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
,
Robert S. White
2   Department of Anesthesiology, Center for Perioperative Outcomes, Weill Cornell Medicine, New York, New York
› Author Affiliations Funding None.
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Abstract

Objective Hospital readmissions are generally higher among racial-ethnic minorities and patients of lower socioeconomic status. However, this has not been widely studied in obstetrics. The aim of the study is to determine 30-day postpartum readmission rates by patient-level social determinants of health: race ethnicity, primary insurance payer, and median income, independently and as effect modifiers.

Study Design Using state inpatient databases from the health care cost and utilization project from 2007 to 2014, we queried all deliveries. To produce accurate estimates of the effects of parturients' social determinants of health on readmission odds while controlling for confounders, generalized linear mixed models (GLMMs) were used. Additional models were generated with interaction terms to highlight any associations and their effect on the outcome. Adjusted odds ratios (aOR) with 95% confidence intervals are reported.

Results There were 5,129,867 deliveries with 79,260 (1.5%) 30-day readmissions. Of these, 947 (1.2%) were missing race ethnicity. Black and Hispanic patients were more likely to be readmitted within 30 days of delivery, as compared with White patients (p < 0.001 and p < 0.05, respectively). Patients with government insurance were more likely to be readmitted than those with private insurance (p < 0.001). Patients living in the second quartile of median income were also more likely to be readmitted than those living in other quartiles (p < 0.05). Using GLMMs, we observed that Black patients with Medicare were significantly more likely to get readmitted as compared with White patients with private insurance (aOR 2.78, 95% CI 2.50–3.09, p < 0.001). Similarly, Black patients living in the fourth (richest) quartile of median income were more likely to get readmitted, even when compared with White patients living in the first (poorest) quartile of median income (aOR 1.48, 95% CI 1.40–1.57, p < 0.001).

Conclusion Significant racial-ethnic disparities in obstetric readmissions were observed, particularly in Black patients with government insurance and even in Black patients living in the richest quartile of median income.

Key Points

  • Using generalized linear mixed models, we observed significant interactions.

  • Government-insured Black patients were 2.78X more likely to be readmitted.

  • The wealthiest Black patients were still 1.48X more likely to be readmitted.

Keywords

delivery - ethnicity - obstetric - race - race ethnicity - readmission - social determinants of health

Note

The findings were presented at the Society for Maternal-Fetal Medicine's 40th Annual Pregnancy Meeting in Grapevine, Texas, February 3rd to 8th, 2020.




Publication History

Received: 15 October 2020

Accepted: 10 October 2021

Article published online:
10 November 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Boozary AS, Manchin III J, Wicker RF. The Medicare Hospital Readmissions Reduction Program: time for reform. JAMA 2015; 314 (04) 347-348
    CrossrefPubMedGoogle Scholar
  • 2 Clapp MA, Little SE, Zheng J, Robinson JN. A multi-state analysis of postpartum readmissions in the United States. Am J Obstet Gynecol 2016; 215 (01) 113.e1-113.e10
    CrossrefPubMedGoogle Scholar
  • 3 Willis E, McManus P, Magallanes N, Johnson S, Majnik A. Conquering racial disparities in perinatal outcomes. Clin Perinatol 2014; 41 (04) 847-875
    CrossrefPubMedGoogle Scholar
  • 4 Aseltine Jr RH, Yan J, Fleischman S, Katz M, DeFrancesco M. Racial and ethnic disparities in hospital readmissions after delivery. Obstet Gynecol 2015; 126 (05) 1040-1047
    CrossrefPubMedGoogle Scholar
  • 5 Aziz A, Gyamfi-Bannerman C, Siddiq Z. et al. Maternal outcomes by race during postpartum readmissions. Am J Obstet Gynecol 2019; 220 (05) 484.e1-484.e10
    CrossrefPubMedGoogle Scholar
  • 6 Kim H, Ross JS, Melkus GD, Zhao Z, Boockvar K. Scheduled and unscheduled hospital readmissions among patients with diabetes. Am J Manag Care 2010; 16 (10) 760-767
    PubMedGoogle Scholar
  • 7 Joynt KE, Orav EJ, Jha AK. Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA 2011; 305 (07) 675-681
    CrossrefPubMedGoogle Scholar
  • 8 Joynt KE, Jha AK. Who has higher readmission rates for heart failure, and why? Implications for efforts to improve care using financial incentives. Circ Cardiovasc Qual Outcomes 2011; 4 (01) 53-59
    CrossrefPubMedGoogle Scholar
  • 9 Rodriguez F, Joynt KE, López L, Saldaña F, Jha AK. Readmission rates for Hispanic Medicare beneficiaries with heart failure and acute myocardial infarction. Am Heart J 2011; 162 (02) 254-261.e3
    CrossrefPubMedGoogle Scholar
  • 10 Menachemi N, Chukmaitov A, Brown LS, Saunders C, Brooks RG. Quality of care differs by patient characteristics: outcome disparities after ambulatory surgical procedures. Am J Med Qual 2007; 22 (06) 395-401
    CrossrefPubMedGoogle Scholar
  • 11 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2017. Natl Vital Stat Rep 2018; 67 (08) 1-50
    PubMedGoogle Scholar
  • 12 DeFrances CJ, Cullen KA, Kozak LJ. National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13 2007; (165) 1-209
    PubMedGoogle Scholar
  • 13 Bateman BT, Mhyre JM, Hernandez-Diaz S. et al. Development of a comorbidity index for use in obstetric patients. Obstet Gynecol 2013; 122 (05) 957-965
    CrossrefPubMedGoogle Scholar
  • 14 Metcalfe A, Lix LM, Johnson JA. et al. Validation of an obstetric comorbidity index in an external population. BJOG 2015; 122 (13) 1748-1755
    CrossrefPubMedGoogle Scholar
  • 15 Clapp MA, Little SE, Zheng J, Robinson JN, Kaimal AJ. The relative effects of patient and hospital factors on postpartum readmissions. J Perinatol 2018; 38 (07) 804-812
    CrossrefPubMedGoogle Scholar
  • 16 Wagner JL, White RS, Tangel V, Gupta S, Pick JS. Socioeconomic, racial, and ethnic disparities in postpartum readmissions in patients with preeclampsia: a multi-state analysis, 2007-2014. J Racial Ethn Health Disparities 2019; 6 (04) 806-820
    CrossrefPubMedGoogle Scholar
  • 17 McKinney J, Keyser L, Clinton S, Pagliano C. ACOG Committee Opinion No. 736: optimizing postpartum care. Obstet Gynecol 2018; 132 (03) 784-785
    CrossrefPubMedGoogle Scholar
  • 18 Tangel V, Gupta S, White RS. Penalties for hospital readmissions. Health Aff (Millwood) 2019; 38 (08) 1410
    CrossrefPubMedGoogle Scholar
  • 19 Howell EA, Zeitlin J. Quality of care and disparities in obstetrics. Obstet Gynecol Clin North Am 2017; 44 (01) 13-25
    CrossrefPubMedGoogle Scholar
  • 20 Howell EA, Zeitlin J. Improving hospital quality to reduce disparities in severe maternal morbidity and mortality. Semin Perinatol 2017; 41 (05) 266-272
    CrossrefPubMedGoogle Scholar