Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health.
Department of Healthcare Economics, UnitedHealthcare, Cypress, California.
JAMA Netw Open. 2021 Apr 1;4(4):e217491. doi: 10.1001/jamanetworkopen.2021.7491.
Women and families constitute the fastest-growing segments of the homeless population. However, there is limited evidence on whether women experiencing homelessness have poorer childbirth delivery outcomes and higher costs of care compared with women not experiencing homelessness.
To compare childbirth delivery outcomes and costs of care between pregnant women experiencing homelessness vs those not experiencing homelessness.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included 15 029 pregnant women experiencing homelessness and 308 242 pregnant women not experiencing homelessness who had a delivery hospitalization in 2014. The study used statewide databases that included all hospital admissions in 3 states (ie, Florida, Massachusetts, and New York). Delivery outcomes and delivery-associated costs were compared between pregnant women experiencing homelessness and those not experiencing homelessness cared for at the same hospital (analyzed using the overlap propensity-score weighting method and multivariable regression models with hospital fixed effects). The Benjamini-Hochberg false discovery rate procedure was used to account for multiple comparisons. Data were analyzed from January 2020 through May 2020.
Housing status at delivery hospitalization.
Outcome variables included obstetric complications (ie, antepartum hemorrhage, placental abnormalities, premature rupture of the membranes, preterm labor, and postpartum hemorrhage), neonatal complications (ie, fetal distress, fetal growth restriction, and stillbirth), delivery method (ie, cesarean delivery), and delivery-associated costs.
Among 15 029 pregnant women experiencing homelessness (mean [SD] age, 28.5 [5.9] years) compared with 308 242 pregnant women not experiencing homelessness (mean [SD] age, 29.4 [5.8] years) within the same hospital, those experiencing homelessness were more likely to experience preterm labor (adjusted probability, 10.5% vs 6.7%; adjusted risk difference [aRD], 3.8%; 95% CI, 1.2%-6.5%; adjusted P = .03) and had higher delivery-associated costs (adjusted costs, $6306 vs $5888; aRD, $417; 95% CI, $156-$680; adjusted P = .02) compared with women not experiencing homelessness. Those experiencing homelessness also had a higher probability of placental abnormalities (adjusted probability, 4.0% vs 2.0%; aRD, 1.9%; 95% CI, 0.4%-3.5%; adjusted P = .053), although this difference was not statistically significant.
This study found that women experiencing homelessness, compared with those not experiencing homelessness, who had a delivery and were admitted to the same hospital were more likely to experience preterm labor and incurred higher delivery-associated costs. These findings suggest wide disparities in delivery-associated outcomes between women experiencing homelessness and those not experiencing homelessness in the US. The findings highlight the importance for health care professionals to actively screen pregnant women for homelessness during prenatal care visits and coordinate their care with community health programs and social housing programs to make sure their health care needs are met.
妇女和家庭是无家可归人口中增长最快的群体。然而，关于无家可归的妇女与没有无家可归经历的妇女相比，分娩结果是否更差，护理成本是否更高，证据有限。
比较无家可归孕妇与无家可归孕妇分娩结果和护理成本。
设计、地点和参与者：这项横断面研究纳入了 2014 年在三个州（即佛罗里达州、马萨诸塞州和纽约州）住院分娩的 15029 名无家可归孕妇和 308242 名无家可归孕妇。该研究使用了包括所有医院入院的全州数据库。无家可归孕妇与在同一家医院接受治疗的无家可归孕妇（使用重叠倾向得分加权法和具有医院固定效应的多变量回归模型进行分析）比较分娩结局和分娩相关费用。采用 Benjamini-Hochberg 假发现率程序来解释多重比较。数据于 2020 年 1 月至 2020 年 5 月进行分析。
分娩住院时的住房状况。
结局变量包括产科并发症（即产前出血、胎盘异常、胎膜早破、早产和产后出血）、新生儿并发症（即胎儿窘迫、胎儿生长受限和死胎）、分娩方式（即剖宫产）和分娩相关费用。
在同一家医院内，与 308242 名无家可归孕妇（平均[标准差]年龄，29.4[5.8]岁）相比，15029 名无家可归孕妇（平均[标准差]年龄，28.5[5.9]岁）中，无家可归孕妇早产的可能性更高（校正概率，10.5%比 6.7%；校正风险差异[ARD]，3.8%；95%CI，1.2%-6.5%；校正 P =.03），且分娩相关费用更高（校正费用，6306 美元比 5888 美元；ARD，417 美元；95%CI，156-680 美元；校正 P =.02），与无家可归孕妇相比。无家可归孕妇也更有可能出现胎盘异常（校正概率，4.0%比 2.0%；ARD，1.9%；95%CI，0.4%-3.5%；校正 P =.053），尽管这一差异无统计学意义。
这项研究发现，与无家可归的孕妇相比，在同一家医院分娩并住院的无家可归孕妇更有可能早产，且分娩相关费用更高。这些发现表明，在美国，无家可归妇女与无家可归妇女在分娩相关结局方面存在广泛差异。这些发现强调了卫生保健专业人员在产前护理就诊期间积极筛查孕妇无家可归状况的重要性，并协调她们的护理工作，与社区卫生项目和社会住房项目合作，以确保她们的医疗需求得到满足。
