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Damodaran K, Brumberg HL, Jawale N, Giblin C, Shah S. Comparison of birth outcomes of mothers covered by Medicaid versus those privately insured when accounting for social determinants of health. J Perinatol 2024; 44:488-492. [PMID: 38082070 DOI: 10.1038/s41372-023-01842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/15/2023] [Accepted: 11/24/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To determine the association between maternal health insurance type and birth outcomes [prematurity, small for gestational age (SGA), Term/Appropriate for gestational age NICU admission (Term/AGA-NICU) & composite birth outcomes (CBO)] accounting for social determinants of health. DESIGN/METHODS A cross-sectional study of maternal surveys and birth certificate data of singleton live births in NY born to mothers with Medicaid (M) or Private Insurance (PI). RESULTS 1015 mothers [M = 631, PI = 384) included. Individual birth outcomes did not differ between groups. Adjusting for social, demographic and clinical covariates, M mothers had similar odds of preterm birth, SGA, Term/AGA-NICU admission and CBO compared to PI. CONCLUSIONS M mothers were as likely as PI mothers to deliver a preterm, SGA or a Term/AGA-NICU infant after controlling for social determinants of health. Despite more social adversity among enrollees, our study suggests NY Medicaid recipients have similar birth outcomes to privately insured, socially advantaged women.
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Affiliation(s)
- Kriti Damodaran
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Heather L Brumberg
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Nilima Jawale
- Division of Neonatology, UHS, Binghamton General Hospital, Binghamton, NY, USA
| | - Clare Giblin
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Shetal Shah
- Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA.
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A comparison of approaches to identify live births using the medicaid analytic extract. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2022; 22:49-58. [PMID: 35463943 PMCID: PMC9031796 DOI: 10.1007/s10742-021-00252-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Medicaid claims are an important, but underutilized source of data for neonatal health services research in the United States. However, identifying live births in Medicaid claims data is challenging due to variation in coding practices by state and year. Methods of identifying live births in Medicaid claims data have not been validated, and it is not known which methods are most appropriate for different research questions. The objective of this study is to describe and validate five approaches to identifying births using Medicaid Analytic eXtract (MAX) from 45 states (2006-2014). We calculated total number of MAX births by state-year using five definitions: (1) any claim within 30 days of birth date listed in personal summary (PS) file, (2) any claim within 7 days of PS birth date, (3) live birth ICD-9 in inpatient or other therapies file, (4) live birth ICD-9 code in inpatient file, (5) live birth ICD-9 in inpatient file with matching PS birth date. We then compared the number of MAX births by state and year to expected counts using outside data sources. Definition 1 identified the most births (14,189,870) and was closest to total expected count (98.3%). Each definition produced over- and underestimates compared to expected counts for given state-years. Findings suggest that the broadest definition of live births (Definition 1) was closest to expected counts, but that the most appropriate definition depends on research question and state-years of interest.
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Moore MD, Mazzoni SE, Wingate MS, Bronstein JM. Characterizing Hypertensive Disorders of Pregnancy Among Medicaid Recipients in a Nonexpansion State. J Womens Health (Larchmt) 2022; 31:261-269. [PMID: 34115529 PMCID: PMC8864437 DOI: 10.1089/jwh.2020.8741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: The incidence of hypertensive disorders of pregnancy (HDP) are on the rise in the United States, especially in the South, which has a heavy chronic disease burden and large number of Medicaid nonexpansion states. Sizeable disparities in HDP outcomes exist by race/ethnicity, geography, and health insurance coverage. Our objective is to explore HDP in the Alabama Medicaid maternity population, and the association of maternal sociodemographic, clinical, and care utilization characteristics with HDP diagnosis. Materials and Methods: Data were from Alabama Medicaid delivery claims in 2017. Bivariate analyses were used to examine maternal characteristics by HDP diagnosis. Hierarchical generalized linear models, with observations nested at the county level, were used to assess multivariable relationships between maternal characteristics and HDP diagnosis. Results: Among women with HDP diagnosis, a higher proportion were older, Black, had other comorbidities, and had more perinatal hospitalizations or emergency visits compared with those without HDP diagnosis. There were increased odds of an HDP diagnosis for older women and those with comorbidities. Black women (adjusted odds ratio [aOR] = 1.24, 95% confidence interval [CI]: 1.16-1.33), women insured only during pregnancy by Sixth Omnibus Reconciliation Act Medicaid (aOR = 1.08, 95% CI: 1.02-1.15), and women entering prenatal care (PNC) in the second trimester (aOR = 1.10, 95% CI: 1.03-1.18) had elevated odds of HDP diagnosis compared with their counterparts. Conclusions: Beyond traditional demographic and clinical risk factors, not having preconception insurance coverage or first trimester PNC entry were associated with higher odds of HDP diagnosis. Improving the provision and timing of maternity coverage among Medicaid recipients, particularly in nonexpansion states, may help identify and treat women at risk of HDP and associated adverse perinatal outcomes.
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Affiliation(s)
- Matthew D. Moore
- Department of Health Care Organization and Policy, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sara E. Mazzoni
- Department of Obstetrics and Gynecology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martha S. Wingate
- Department of Health Care Organization and Policy, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Janet M. Bronstein
- Department of Health Care Organization and Policy, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Disparities in infant mortality by payment source for delivery in the United States. Prev Med 2021; 145:106361. [PMID: 33309872 DOI: 10.1016/j.ypmed.2020.106361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/13/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
In this study, we hypothesized that infant mortality varies among health insurance status. Furthermore, we examined whether there are racial and ethnic disparities in the association between infant death and payment source for delivery. Our study used US national linked birth and infant death data for 2013 and 2017 collected by the National Center for Health Statistics and included 3,311,504 and 3,218,168 live births for each year. The principal source of payment for delivery was classified into three groups: Medicaid, private insurance, and self-payment. The outcome measures were infant mortality, neonatal mortality, and postneonatal mortality. Subgroup analysis for race and ethnicity was also performed. Overall infant mortality was lower in mothers who paid with private insurance than in those who paid with Medicaid insurance (RR = 0.87, 95% CI 0.84-0.90 in 2013; RR = 0.91, 95% CI 0.87-0.94 in 2017), but it was higher in self-paid women than in Medicaid-insured women at delivery (RR = 1.25, 95% CI 1.17-1.33 in 2013; RR = 1.16, 95% CI 1.08-1.24 in 2017). Non-Hispanic black (RR = 1.67, 95% CI 1.47-1.90 in 2013; RR = 1.16, 95% CI 1.00-1.35 in 2017) and Hispanic (RR = 1.30, 95% CI 1.17-1.44 in 2013; RR = 1.22, 95% CI 1.09-1.36 in 2017) mothers with self-payment had a higher risk for infant mortality than those with Medicaid at delivery. Newborns whose mothers have no health insurance would be more vulnerable to infant mortality than Medicaid beneficiaries, and non-white ethnic groups with self-payment would have an elevated risk of infant mortality among other racial and ethnic groups.
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Guglielminotti J, Landau R, Wong CA, Li G. Patient-, Hospital-, and Neighborhood-Level Factors Associated with Severe Maternal Morbidity During Childbirth: A Cross-Sectional Study in New York State 2013–2014. Matern Child Health J 2018; 23:82-91. [DOI: 10.1007/s10995-018-2596-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lapato DM, Moyer S, Olivares E, Amstadter AB, Kinser PA, Latendresse SJ, Jackson-Cook C, Roberson-Nay R, Strauss JF, York TP. Prospective longitudinal study of the pregnancy DNA methylome: the US Pregnancy, Race, Environment, Genes (PREG) study. BMJ Open 2018; 8:e019721. [PMID: 29743320 PMCID: PMC5942473 DOI: 10.1136/bmjopen-2017-019721] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/15/2018] [Accepted: 02/16/2018] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The goal of the Pregnancy, Race, Environment, Genes study was to understand how social and environmental determinants of health (SEDH), pregnancy-specific environments (PSE) and biological processes influence the timing of birth and account for the racial disparity in preterm birth. The study followed a racially diverse longitudinal cohort throughout pregnancy and included repeated measures of PSE and DNA methylation (DNAm) over the course of gestation and up to 1 year into the postpartum period. PARTICIPANTS All women were between 18 and 40 years of age with singleton pregnancies and no diagnosis of diabetes or indication of assisted reproductive technology. Both mother and father had to self-identify as either African-American (AA) or European-American (EA). Maternal peripheral blood samples along with self-report questionnaires measuring SEDH and PSE factors were collected at four pregnancy visits, and umbilical cord blood was obtained at birth. A subset of participants returned for two additional postpartum visits, during which additional questionnaires and maternal blood samples were collected. The pregnancy and postpartum extension included n=240 (AA=126; EA=114) and n=104 (AA=50; EA=54), respectively. FINDINGS TO DATE One hundred seventy-seven women (AA=89, EA=88) met full inclusion criteria out of a total of 240 who were initially enrolled. Of the 63 participants who met exclusion criteria after enrolment, 44 (69.8%) were associated with a medical reason. Mean gestational age at birth was significantly shorter for the AA participants by 5.1 days (M=272.5 (SD=10.5) days vs M=277.6 (SD=8.3)). FUTURE PLANS Future studies will focus on identifying key environmental factors that influence DNAm change across pregnancy and account for racial differences in preterm birth.
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Affiliation(s)
- Dana M Lapato
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Sara Moyer
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Ananda B Amstadter
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Patricia A Kinser
- Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Shawn J Latendresse
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Colleen Jackson-Cook
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roxann Roberson-Nay
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jerome F Strauss
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Timothy P York
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA
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Abstract
AIM To report an analysis of the concept of patient engagement in prenatal care. BACKGROUND Engagement in health care has been widely discussed but vaguely defined. Patients benefit more from their health care when they are fully engaged in their care. Patient engagement in prenatal care is an important element of prenatal care utilization that has not been analyzed, standardized as a concept, or measured. DESIGN Concept analysis. DATA SOURCES CINAHL, MEDLINE, PsycINFO databases, and the internet were searched for literature published in English with a focus on peer-reviewed journals from disciplines of business, allied health sciences, health administration, psychology, and nursing, focusing on the period of 2010-2015. METHODS Hybrid version of the Walker and Avant concept analysis method (2011). RESULTS This concept analysis provides 4 defining attributes of patient engagement in prenatal care and a table of related empirical referents of engagement. These elements offer a foundation for further nursing scholarship toward measurement and evaluation of patient engagement in prenatal care. CONCLUSION Patient engagement in prenatal care represents a human response to a health condition. Efforts to increase patient engagement in health care are best addressed by the nursing profession through continued research and intervention development.
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Affiliation(s)
- Phyllis Dyess-Nugent
- College of Nursing and Health Sciences, The University of Texas at Tyler, Tyler, Texas
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Harvey SM, Oakley LP, Yoon J, Luck J. Coordinated Care Organizations: Neonatal and Infant Outcomes in Oregon. Med Care Res Rev 2017; 76:627-642. [PMID: 29161977 DOI: 10.1177/1077558717741980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2012, Oregon's Medicaid program implemented a comprehensive accountable care model delivered through coordinated care organizations (CCOs). Because CCOs are expected to improve utilization of services and health outcomes, neonatal and infant outcomes may be important indicators of their impact. Estimating difference-in-differences models, we compared prepost CCO changes in outcomes (e.g., low birth weight, abnormal conditions, 5-minute Apgar score, congenital anomalies, and infant mortality) between Medicaid and non-Medicaid births among 99,924 infants born in Oregon during 2011 and 2013. We further examined differences in the impact of CCOs by ethnicity and rurality. Following CCO implementation the likelihood of low birth weight and abnormal conditions decreased by 0.95% and 1.08%, a reduction of 13.4% and 10.4% compared with the pre-CCO level for Medicaid enrollees, respectively. These reductions could be predictive of lifelong health benefits for infants and lower costs for acute care and are, therefore, important markers of success for the CCO model.
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Affiliation(s)
| | | | - Jangho Yoon
- 1 Oregon State University, Corvallis, OR, USA
| | - Jeff Luck
- 1 Oregon State University, Corvallis, OR, USA
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Seravalli L, Patterson F, Nelson DB. Role of perceived stress in the occurrence of preterm labor and preterm birth among urban women. J Midwifery Womens Health 2014; 59:374-9. [PMID: 24890400 PMCID: PMC4115024 DOI: 10.1111/jmwh.12088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study examined whether prenatal perceived stress levels during pregnancy were associated with preterm labor or preterm birth. METHODS Perceived stress levels were measured at 16 weeks' gestation or less and between 20 and 24 weeks' gestation in a sample of 1069 low-income pregnant women attending Temple University prenatal care clinics. Scores were averaged to create a single measure of prenatal stress. Preterm birth was defined as the occurrence of a spontaneous birth prior to 37 weeks' gestation. Preterm labor was defined as the occurrence of regular contractions between 20 and 37 weeks' gestation that were associated with changes in the cervix. RESULTS Independent of potential confounding factors, prenatal perceived stress was not associated with preterm labor (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.69-1.78; P = .66); however, prenatal stress trended toward an association with preterm birth (OR, 1.49; 95% CI, 1.00-2.23; P = .05). The strongest predictor of preterm labor was a history of preterm labor in a prior pregnancy. Women with a history of preterm labor were 2 times more likely to experience preterm labor in the current pregnancy than women who did not have a preterm labor history (OR, 2.16; 95% CI, 1.05-4.41; P = .04). Historical risk factors for preterm birth, such as African American race, a history of abortion, or a history of preterm birth, were not related to preterm labor. The strongest predictor of preterm birth was having a history of preterm birth in a prior pregnancy (OR, 2.55; 95% CI, 1.54-4.24; P < .001). DISCUSSION Prenatal perceived stress levels may be a risk factor for preterm birth independent of preterm labor; however, prenatal stress was not associated with preterm labor. Risk factors for preterm labor may be different from those of preterm birth.
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Identifying Multiple Risks of Low Birth Weight Using Person-Centered Modeling. Womens Health Issues 2014; 24:e251-6. [DOI: 10.1016/j.whi.2014.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 11/19/2022]
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Zhang S, Cardarelli K, Shim R, Ye J, Booker KL, Rust G. Racial disparities in economic and clinical outcomes of pregnancy among Medicaid recipients. Matern Child Health J 2013; 17:1518-25. [PMID: 23065298 PMCID: PMC4039287 DOI: 10.1007/s10995-012-1162-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To explore racial-ethnic disparities in adverse pregnancy outcomes among Medicaid recipients, and to estimate excess Medicaid costs associated with the disparities. Cross-sectional study of adverse pregnancy outcomes and Medicaid payments using data from Medicaid Analytic eXtract files on all Medicaid enrollees in fourteen southern states. Compared to other racial and ethnic groups, African American women tended to be younger, more likely to have a Cesarean section, to stay longer in the hospital and to incur higher Medicaid costs. African-American women were also more likely to experience preeclampsia, placental abruption, preterm birth, small birth size for gestational age, and fetal death/stillbirth. Eliminating racial disparities in adverse pregnancy outcomes (not counting infant costs), could generate Medicaid cost savings of $114 to $214 million per year in these 14 states. Despite having the same insurance coverage and meeting the same poverty guidelines for Medicaid eligibility, African American women have a higher rate of adverse pregnancy outcomes than White or Hispanic women. Racial disparities in adverse pregnancy outcomes not only represent potentially preventable human suffering, but also avoidable economic costs. There is a significant financial return-on-investment opportunity tied to eliminating racial disparities in birth outcomes. With the Affordable Care Act expansion of Medicaid coverage for the year 2014, Medicaid could be powerful public health tool for improving pregnancy outcomes.
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Affiliation(s)
- Shun Zhang
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
| | - Kathryn Cardarelli
- Department of Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ruth Shim
- Department of Psychiatry, Morehouse School of Medicine, Atlanta, GA, USA
| | - Jiali Ye
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
| | - Karla L. Booker
- Division of Maternal-Child Health, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - George Rust
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
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