Mallinson David C, Nkhoma-Mussa Yamikani B, Gillespie Kate H, Brown Roger L
Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.
School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Health Serv Res. 2025 Apr;60 Suppl 2(Suppl 2):e14437. doi: 10.1111/1475-6773.14437. Epub 2025 Jan 14.
To estimate associations between Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program and infant mortality.
We analyzed birth records, Medicaid claims, and infant death records for all resident and in-state Medicaid-paid live deliveries during 2010-2018.
We measured PNCC exposure during pregnancy dichotomously (none; any) and categorically (none; assessment/care plan only; service receipt). Our outcome was infant mortality (death at age < 365 days). Adjusted binary logit regressions and propensity score weighted regressions tested associations between PNCC receipt and infant mortality, and we estimated probabilities and average marginal effects of infant mortality. We also executed regressions with interactions on maternal race/ethnicity to determine if associations varied across Black non-Hispanic (NH), Hispanic, and White NH births.
DATA COLLECTION/EXTRACTION METHODS: Our sample consisted of 231,540 Medicaid-paid births during 2010-2018. PNCC is only available to pregnant Medicaid beneficiaries.
Infant mortality was lower among PNCC assessment/care plan only births (5.0 deaths/1000 births) and PNCC service receipt births (6.1 deaths/1000 births) relative to non-PNCC births (6.8 deaths/1000 births). This pattern was consistent in Black NH and Hispanic subgroups, but infant mortality did not vary by PNCC among White NH deliveries. Overall, adjusted binary logit regressions indicated that the probabilities of infant mortality were 0.70% for no PNCC and 0.53% for any PNCC, yielding an average marginal effect of -0.17 percentage points (95% confidence interval -0.22 percentage points, -0.11 percentage points). This association did not vary by PNCC exposure level. PNCC-infant mortality associations were significantly stronger for Black NH births relative to White NH births. Results were consistent in propensity score weighted regressions.
PNCC during pregnancy is associated with a lower probability of infant mortality, particularly in Black NH families. The benefit of PNCC on infant mortality may not depend on receiving services beyond care planning.
评估威斯康星医疗补助计划的产前护理协调（PNCC）项目与婴儿死亡率之间的关联。
我们分析了2010 - 2018年期间所有本州居民以及本州医疗补助支付的活产分娩的出生记录、医疗补助理赔记录和婴儿死亡记录。
我们将孕期接受PNCC的情况分为两类（未接受；接受）和多类（未接受；仅接受评估/护理计划；接受服务）。我们的研究结果是婴儿死亡率（年龄<365天死亡）。调整后的二元逻辑回归和倾向得分加权回归用于检验接受PNCC与婴儿死亡率之间的关联，我们估计了婴儿死亡率的概率和平均边际效应。我们还进行了包含孕产妇种族/族裔交互项的回归分析，以确定不同种族（非西班牙裔黑人、西班牙裔和非西班牙裔白人）出生的婴儿中，这种关联是否存在差异。
数据收集/提取方法：我们的样本包括2010 - 2018年期间231,540例医疗补助支付的分娩。PNCC仅适用于孕期医疗补助受益人。
相对于未接受PNCC的分娩（每1000例分娩中有6.8例死亡），仅接受PNCC评估/护理计划的分娩（每1000例分娩中有5.0例死亡）和接受PNCC服务的分娩（每1000例分娩中有6.1例死亡）的婴儿死亡率较低。这种模式在非西班牙裔黑人及西班牙裔亚组中一致，但在非西班牙裔白人分娩中，婴儿死亡率并未因PNCC而有所不同。总体而言，调整后的二元逻辑回归表明，未接受PNCC的婴儿死亡率概率为0.70%，接受任何PNCC的为0.53%，平均边际效应为 - 0.17个百分点（95%置信区间为 - 0.22个百分点， - 0.11个百分点）。这种关联不因PNCC暴露水平而变化。相对于非西班牙裔白人出生的婴儿，PNCC与婴儿死亡率之间的关联在非西班牙裔黑人出生的婴儿中显著更强。倾向得分加权回归的结果一致。
孕期接受PNCC与较低的婴儿死亡率相关，尤其是在非西班牙裔黑人家庭中。PNCC对婴儿死亡率的益处可能不取决于接受护理计划之外的服务。
