Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York; the Departments of Obstetrics and Gynecology and Psychiatry and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; and the Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, the Hennepin Healthcare Research Institute, and the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
Obstet Gynecol. 2020 Apr;135(4):917-924. doi: 10.1097/AOG.0000000000003728.
To measure the association between race-ethnicity and insurance status at preconception, delivery, and postpartum and the frequency of insurance gaps and transitions (disruptions) across these time points.
We conducted a cross-sectional analysis of survey data from 107,921 women in 40 states participating in the Centers for Disease Control and Prevention's Pregnancy Risk Assessment and Monitoring System from 2015 to 2017. We calculated unadjusted estimates of insurance status at preconception, delivery, and postpartum and continuity across these time points for seven racial-ethnic categories (white non-Hispanic, black non-Hispanic, indigenous, Asian or Pacific Islander, Hispanic Spanish-speaking, Hispanic English-speaking, and mixed race or other). We also examined unadjusted estimates of uninsurance at each perinatal time period by state of residence. We calculated adjusted differences in the predicted probability of uninsurance at preconception, delivery, and postpartum using logistic regression models with interaction terms for race-ethnicity and income.
For each perinatal time point, all categories of racial-ethnic minority women experienced higher rates of uninsurance than white non-Hispanic women. From preconception to postpartum, 75.3% (95% CI 74.7-75.8) of white non-Hispanic women had continuous insurance compared with 55.4% of black non-Hispanic women (95% CI 54.2-56.6), 49.9% of indigenous women (95% CI 46.8-53.0) and 20.5% of Hispanic Spanish-speaking women (95% CI 18.9-22.2). In adjusted models, lower-income Hispanic women and indigenous women had a significantly higher predicted probability of uninsurance in the preconception and postpartum period compared with white non-Hispanic women.
Disruptions in perinatal insurance coverage disproportionately affect indigenous, Hispanic, and black non-Hispanic women. Differential insurance coverage may have important implications for racial-ethnic disparities in access to perinatal care and maternal-infant health.
测量种族和族裔与孕前、分娩和产后保险状况之间的关联，以及这些时间点上保险缺口和转变（中断）的频率。
我们对 2015 年至 2017 年间参加疾病控制与预防中心妊娠风险评估和监测系统的来自 40 个州的 107921 名妇女的调查数据进行了横断面分析。我们计算了七个种族和族裔类别（白人非西班牙裔、黑人非西班牙裔、土著、亚洲或太平洋岛民、西班牙语裔、英语西班牙语裔和混合种族或其他）的孕前、分娩和产后的保险状况的未调整估计值以及这些时间点的连续性。我们还检查了按居住州划分的每个围产期无保险率的未调整估计值。我们使用具有种族和族裔与收入交互项的逻辑回归模型，计算了孕前、分娩和产后无保险的预测概率的调整差异。
在每个围产期时间点，所有少数族裔妇女的无保险率都高于白人非西班牙裔妇女。从孕前到产后，75.3%（95%CI 74.7-75.8）的白人非西班牙裔妇女连续投保，而黑人非西班牙裔妇女为 55.4%（95%CI 54.2-56.6），土著妇女为 49.9%（95%CI 46.8-53.0），西班牙语裔妇女为 20.5%（95%CI 18.9-22.2）。在调整后的模型中，低收入的西班牙裔妇女和土著妇女在孕前和产后无保险的预测概率明显高于白人非西班牙裔妇女。
围产期保险覆盖的中断不成比例地影响土著、西班牙裔和黑人非西班牙裔妇女。保险覆盖的差异可能对种族和族裔在获得围产期护理和母婴健康方面的差异产生重要影响。
