University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Institute for Medicaid Innovation, Washington, District of Columbia.
Womens Health Issues. 2021 May-Jun;31(3):245-253. doi: 10.1016/j.whi.2020.12.005. Epub 2021 Jan 21.
Severe maternal morbidity (SMM) affects 50,000 deliveries in the United States annually, with around 1.5 times the rates among Medicaid-covered relative to privately covered deliveries. Furthermore, large racial inequities exist in SMM for non-Hispanic Black women and Hispanic women with rates being 2.1 and 1.4 times higher than White women, respectively. This study aimed to compare the differences in SMM among women of different races/ethnicities and delivery insurance types. Quantifying the rates of SMM based on the intersection of race/ethnicity and insurance status can help to elucidate how multiple forms of oppression and racism may contribute to the substantial inequities in SMM among Black women.
Using hospital discharge data from the Healthcare Cost and Utilization Project National Inpatient Sample (years 2016 and 2017), we conducted multivariate logistic models to evaluate equity in maternal outcomes among women with different primary payers, overall and stratified by race/ethnicity.
We found a rate of SMM equal to 138.3 per 10,000 deliveries. Differences in the rate of SMM among non-Hispanic Black, non-Hispanic Asian, and Hispanic women relative to White women were lower among Medicaid-covered deliveries relative to deliveries of all payer types. For example, among all payers, Black women had 2.17 (221.3 vs. 102.1 per 10,000) times the rate of SMM compared with White women; however, among Medicaid-covered deliveries, Black women had 1.84 (227.3 vs. 123.2) times the rate. Despite increased risk associated with Medicaid coverage (adjusted odds ratio, 1.12; 95% confidence interval, 1.07-1.16), the risk was no longer significant in the stratified regression including Black women (adjusted odds ratio, 1.06; 95% confidence interval, 0.98-1.15).
Our findings suggest that Black women with Medicaid do not have higher rates of SMM relative to Black women with private insurance. National and state policy efforts should continue to focus on addressing structural racism and other socioeconomic drivers of adverse maternal outcomes, including barriers to high-quality care among women with Medicaid coverage.
在美国，每年有 5 万名产妇发生严重的产妇发病率（SMM），其中 Medicaid 覆盖的产妇发病率是私人保险覆盖的产妇发病率的 1.5 倍。此外，非西班牙裔黑人女性和西班牙裔女性的 SMM 存在较大的种族不平等现象，其发病率分别是非西班牙裔白人女性的 2.1 倍和 1.4 倍。本研究旨在比较不同种族/族裔和分娩保险类型的女性之间 SMM 的差异。根据种族/族裔和保险状况的交叉点来量化 SMM 的发生率，可以帮助阐明多种形式的压迫和种族主义如何导致黑人女性的 SMM 存在实质性的不平等。
利用 Healthcare Cost and Utilization Project National Inpatient Sample（2016 年和 2017 年）的医院出院数据，我们进行了多变量逻辑模型分析，以评估不同主要付款人（overall）和按种族/族裔分层（stratified）的产妇结局的公平性。
我们发现 SMM 的发生率为每 10000 次分娩 138.3 例。与所有付款人类型相比， Medicaid 覆盖的分娩中，非西班牙裔黑人、非西班牙裔亚洲人和西班牙裔女性的 SMM 发生率差异较低。例如，在所有付款人中，黑人女性的 SMM 发生率是白人女性的 2.17 倍（221.3 比 102.1/10000）；然而，在 Medicaid 覆盖的分娩中，黑人女性的 SMM 发生率为 1.84 倍（227.3 比 123.2）。尽管 Medicaid 覆盖的风险增加（调整后的优势比，1.12；95%置信区间，1.07-1.16），但在包括黑人女性的分层回归中，这一风险不再显著（调整后的优势比，1.06；95%置信区间，0.98-1.15）。
我们的研究结果表明，与拥有私人保险的黑人女性相比，拥有 Medicaid 的黑人女性的 SMM 发生率并没有更高。国家和州的政策努力应继续专注于解决结构性种族主义和其他影响不良产妇结局的社会经济驱动因素，包括 Medicaid 覆盖的女性获得高质量护理的障碍。
