Katz S J, Armstrong R W, LoGerfo J P
Department of Medicine, University of Michigan, Ann Arbor.
Am J Public Health. 1994 Jun;84(6):986-91. doi: 10.2105/ajph.84.6.986.
The purpose of this study was to examine differences in adequacy of prenatal care and incidence of low birthweight between low-income women with Medicaid in Washington State and low-income women with Canadian provincial health insurance in British Columbia.
A population-based cross-sectional study was done by using linked birth certificates and claims data.
Overall, the adjusted odds ratio for inadequate prenatal care in Washington (comparing women with Medicaid with those with private insurance) was 3.2. However, the risk varied by time of Medicaid enrollment relative to pregnancy (2.0, 1.0, 2.7, 6.3; for women who enrolled prior to pregnancy, during the first trimester, during the second trimester, or during the third trimester, respectively). In British Columbia, the adjusted odds ratio for inadequate care (comparing women receiving a health premium subsidy with those receiving no subsidy) was 1.5 for women receiving a 100% subsidy and 1.2 for women receiving a 95% subsidy. The risk for low birthweight followed a similar trend in both regions, but there was no association with enrollment period in Washington.
Overall, the risk for inadequate prenatal care among poor women was much greater in Washington than in British Columbia. Most of the difference was due to Washington women's delayed enrollment in Medicaid. In both regions, the poor were at similar risk for low birthweight relative to their more affluent counterparts.
本研究旨在探讨华盛顿州有医疗补助的低收入女性与不列颠哥伦比亚省有加拿大省级医疗保险的低收入女性在产前护理充足率和低出生体重发生率方面的差异。
采用关联出生证明和理赔数据进行基于人群的横断面研究。
总体而言，华盛顿州产前护理不足的校正比值比（将有医疗补助的女性与有私人保险的女性进行比较）为3.2。然而，相对于怀孕时间，医疗补助登记的风险有所不同（分别为2.0、1.0、2.7、6.3；对于在怀孕前、孕早期、孕中期或孕晚期登记的女性）。在不列颠哥伦比亚省，护理不足的校正比值比（将获得健康保费补贴的女性与未获得补贴的女性进行比较），对于获得100%补贴的女性为1.5，对于获得95%补贴的女性为1.2。两个地区低出生体重的风险遵循类似趋势，但在华盛顿州与登记时间无关。
总体而言，华盛顿州贫困女性产前护理不足的风险远高于不列颠哥伦比亚省。大部分差异是由于华盛顿州女性延迟登记医疗补助。在两个地区，相对于较为富裕的女性，贫困女性出生低体重的风险相似。
