1
|
Kozhimannil KB, Sheffield EC, Fritz AH, Interrante JD, Henning-Smith C, Lewis VA. Health insurance coverage and experiences of intimate partner violence and postpartum abuse screening among rural US residents who gave birth 2016-2020. J Rural Health 2024. [PMID: 38733132 DOI: 10.1111/jrh.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 03/11/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE Intimate partner violence (IPV) is elevated among rural residents and contributes to maternal morbidity and mortality. Postpartum health insurance expansion efforts could address multiple causes of maternal morbidity and mortality, including IPV. The objective of this study was to describe the relationship between perinatal health insurance, IPV, and postpartum abuse screening among rural US residents. METHODS Using 2016-2020 data on rural residents from the Pregnancy Risk Assessment Monitoring System, we assessed self-report of experiencing physical violence by an intimate partner and rates of abuse screening at postpartum visits. Health insurance at childbirth and postpartum was categorized as private, Medicaid, or uninsured. We also measured insurance transitions from childbirth to postpartum (continuous private, continuous Medicaid, Medicaid to private, and Medicaid to uninsured). FINDINGS IPV rates varied by health insurance status at childbirth, with the highest rates among Medicaid beneficiaries (7.7%), compared to those who were uninsured (1.6%) or privately insured (1.6%). When measured by insurance transitions, the highest IPV rates were reported by those with continuous Medicaid coverage (8.6%), followed by those who transitioned from Medicaid at childbirth to private insurance (5.3%) or no insurance (5.9%) postpartum. Nearly half (48.1%) of rural residents lacked postpartum abuse screening, with the highest proportion among rural residents who were uninsured at childbirth (66.1%) or postpartum (52.1%). CONCLUSION Rural residents who are insured by Medicaid before or after childbirth are at elevated risk for IPV. Medicaid policy efforts to improve maternal health should focus on improving detection and screening for IPV among rural residents.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and Management, Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Emily C Sheffield
- Division of Health Policy and Management, Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Alyssa H Fritz
- Division of Health Policy and Management, Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Julia D Interrante
- Division of Health Policy and Management, Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Carrie Henning-Smith
- Division of Health Policy and Management, Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Valerie A Lewis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
2
|
Kozhimannil KB, Sheffield EC, Fritz AH, Henning‐Smith C, Interrante JD, Lewis VA. Rural/urban differences in rates and predictors of intimate partner violence and abuse screening among pregnant and postpartum United States residents. Health Serv Res 2024; 59:e14212. [PMID: 37553107 PMCID: PMC10915503 DOI: 10.1111/1475-6773.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE To describe rates and predictors of perinatal intimate partner violence (IPV) and rates and predictors of not being screened for abuse among rural and urban IPV victims who gave birth. DATA SOURCES AND STUDY SETTING This analysis utilized 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 45 states and three jurisdictions. STUDY DESIGN This is a retrospective, cross-sectional study using multistate survey data. DATA COLLECTION/EXTRACTION METHODS This analysis included 201,413 survey respondents who gave birth in 2016-2020 (n = 42,193 rural and 159,220 urban respondents). We used survey-weighted multivariable logistic regression models, stratified by rural/urban residence, to estimate adjusted predicted probabilities and 95% confidence intervals (CIs) for two outcomes: (1) self-reported experiences of IPV (physical violence by a current or former intimate partner) and (2) not receiving abuse screening at health care visits before, during, or after pregnancy. PRINCIPAL FINDINGS Rural residents had a higher prevalence of perinatal IPV (4.6%) than urban residents (3.2%). Rural respondents who were Medicaid beneficiaries, 18-35 years old, non-Hispanic white, Hispanic (English-speaking), or American Indian/Alaska Native had significantly higher predicted probabilities of experiencing perinatal IPV compared with their urban counterparts. Among respondents who experienced perinatal IPV, predicted probabilities of not receiving abuse screening were 21.3% for rural and 16.5% for urban residents. Predicted probabilities of not being screened for abuse were elevated for rural IPV victims who were Medicaid beneficiaries, 18-24 years old, or unmarried, compared to urban IPV victims with those same characteristics. CONCLUSIONS IPV is more common among rural birthing people, and rural IPV victims are at higher risk of not being screened for abuse compared with their urban peers. IPV prevention and support interventions are needed in rural communities and should focus on universal abuse screening during health care visits and targeted support for those at greatest risk of perinatal IPV.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and ManagementUniversity of Minnesota Rural Health Research Center, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
- Division of Health Policy and ManagementUniversity of Minnesota, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Emily C. Sheffield
- Division of Health Policy and ManagementUniversity of Minnesota Rural Health Research Center, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
- Division of Health Policy and ManagementUniversity of Minnesota, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Alyssa H. Fritz
- Division of Health Policy and ManagementUniversity of Minnesota Rural Health Research Center, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
- Division of Health Policy and ManagementUniversity of Minnesota, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Carrie Henning‐Smith
- Division of Health Policy and ManagementUniversity of Minnesota Rural Health Research Center, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
- Division of Health Policy and ManagementUniversity of Minnesota, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Julia D. Interrante
- Division of Health Policy and ManagementUniversity of Minnesota Rural Health Research Center, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
- Division of Health Policy and ManagementUniversity of Minnesota, University of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Valerie A. Lewis
- Department of Health Policy and ManagementGillings School of Global Public Health, University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| |
Collapse
|
3
|
Jindal M, Barnert E, Chomilo N, Gilpin Clark S, Cohen A, Crookes DM, Kershaw KN, Kozhimannil KB, Mistry KB, Shlafer RJ, Slopen N, Suglia SF, Nguemeni Tiako MJ, Heard-Garris N. Policy solutions to eliminate racial and ethnic child health disparities in the USA. Lancet Child Adolesc Health 2024; 8:159-174. [PMID: 38242598 DOI: 10.1016/s2352-4642(23)00262-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 01/21/2024]
Abstract
Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.
Collapse
Affiliation(s)
- Monique Jindal
- Department of Medicine, University of Illinois Chicago School of Medicine, Chicago, IL, USA.
| | - Elizabeth Barnert
- Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Nathan Chomilo
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Shawnese Gilpin Clark
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alyssa Cohen
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danielle M Crookes
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA; Department of Sociology and Anthropology, College of Social Sciences and Humanities, Northeastern University, Boston, MA, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kamila B Mistry
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD, USA
| | - Rebecca J Shlafer
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA; Center on the Developing Child, Harvard University, Boston, MA, USA
| | - Shakira F Suglia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Nia Heard-Garris
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Institute for Policy Research, Northwestern University, Chicago, IL, USA
| |
Collapse
|
4
|
Interrante JD, Fritz AH, McCoy MB, Kozhimannil KB. Effects of Breastfeeding Peer Counseling on County-Level Breastfeeding Rates Among WIC Participants in Greater Minnesota. Womens Health Issues 2024:S1049-3867(23)00212-8. [PMID: 38195269 DOI: 10.1016/j.whi.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE U.S. breastfeeding outcomes consistently fall short of public health targets, with lower rates among rural and low-income people, as well as participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The U.S. Department of Agriculture funded a subset of local WIC agencies in Minnesota to implement Breastfeeding Peer Counseling Programs (BFPCs) aimed at improving breastfeeding rates. We examined the impact of BFPCs on breastfeeding rates among WIC participants in Greater Minnesota (outside the Minneapolis-St. Paul metropolitan area). METHODS We used data from the Minnesota WIC Information System for the years 2012 through 2019 to estimate the impact of peer counseling on breastfeeding duration using difference-in-differences models. Additionally, we examined results among rural counties and assessed the possibility of spillover effects by stratifying whether a county without BFPCs bordered one with BFPCs. RESULTS Availability of BFPCs resulted in a 3.1 to 3.4 percentage-point increase in breastfeeding rates at 3 months and a 3.2 to 3.7 percentage-point increase in breastfeeding rates at 6 months among WIC participants in Greater Minnesota. Among rural counties, results showed a statistically significant 4.1 to 5.2 percentage-point increase in breastfeeding duration rates. Both border and nonborder counties experienced positive impacts of BFPCs on breastfeeding rates, suggesting wide-ranging program spillover effects. CONCLUSIONS BFPCs had a significant positive impact on breastfeeding duration. Findings indicate an opportunity for improving rural breastfeeding rates through increased funding for WIC BFPCs.
Collapse
Affiliation(s)
- Julia D Interrante
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
| | - Alyssa H Fritz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Marcia B McCoy
- Minnesota Department of Health Special Supplemental Nutrition Program for Women, Infants, and Children, Division of Child and Family Health, St Paul, Minnesota
| | - Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
5
|
Leonard SA, Phibbs CS, Main EK, Kozhimannil KB, Bateman BT. In Reply. Obstet Gynecol 2024; 143:e18-e19. [PMID: 38096558 DOI: 10.1097/aog.0000000000005457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Stephanie A Leonard
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Ciaran S Phibbs
- Department of Pediatrics, Stanford University, Stanford, and Health Economics Resource Center, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California
| | - Elliott K Main
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | | | - Brian T Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| |
Collapse
|
6
|
Leonard SA, Formanowski BL, Phibbs CS, Lorch S, Main EK, Kozhimannil KB, Passarella M, Bateman BT. Chronic Hypertension in Pregnancy and Racial-Ethnic Disparities in Complications. Obstet Gynecol 2023; 142:862-871. [PMID: 37678888 PMCID: PMC10510794 DOI: 10.1097/aog.0000000000005342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To evaluate whether there are individual- and population-level associations between chronic hypertension and pregnancy complications, and to assess differences across seven racial-ethnic groups. METHODS This population-based study used linked vital statistics and hospitalization discharge data from all live and stillbirths in California (2008-2018), Michigan (2008-2020), Oregon (2008-2020), Pennsylvania (2008-2014), and South Carolina (2008-2020). We used multivariable log-binomial regression models to estimate risk ratios (RRs) and population attributable risk (PAR) percentages with 95% CIs for associations between chronic hypertension and several obstetric and neonatal outcomes, selected based on prior evidence and pathologic pathways. We adjusted models for demographic factors (race and ethnicity, payment method, educational attainment), age, body mass index, obstetric history, delivery year, and state, and conducted analyses stratified across seven racial-ethnic groups. RESULTS The study included 7,955,713 pregnancies, of which 168,972 (2.1%) were complicated by chronic hypertension. Chronic hypertension was associated with several adverse obstetric and neonatal outcomes, with the largest adjusted PAR percentages observed for preeclampsia with severe features or eclampsia (22.4; 95% CI 22.2-22.6), acute renal failure (13.6; 95% CI 12.6-14.6), and pulmonary edema (10.7; 95% CI 8.9-12.6). Estimated RRs overall were similar across racial-ethnic groups, but PAR percentages varied. The adjusted PAR percentages (95% CI) for severe maternal morbidity-a widely used composite of acute severe events-for people who were American Indian or Alaska Native, Asian, Black, Latino, Native Hawaiian or Other Pacific Islander, White, and Multiracial or Other were 5.0 (1.1-8.8), 3.7 (3.0-4.3), 9.0 (8.2-9.8), 3.9 (3.6-4.3), 11.6 (6.4-16.5), 3.2 (2.9-3.5), and 5.5 (4.2-6.9), respectively. CONCLUSION Chronic hypertension accounts for a substantial fraction of obstetric and neonatal morbidity and contributes to higher complication rates, particularly for people who are Black or Native Hawaiian or Other Pacific Islander.
Collapse
Affiliation(s)
- Stephanie A Leonard
- Department of Obstetrics and Gynecology, the Department of Pediatrics, and the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, and the Health Economics Resource Center, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California; the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and the Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Kozhimannil KB. Declining access to US maternity care is a systemic injustice. BMJ 2023; 382:2038. [PMID: 37678911 DOI: 10.1136/bmj.p2038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minnesota, USA
- University of Minnesota Rural Health Research Center, Minnesota, USA
| |
Collapse
|
8
|
Kozhimannil KB, Leonard SA, Handley SC, Passarella M, Main EK, Lorch SA, Phibbs CS. Obstetric Volume and Severe Maternal Morbidity Among Low-Risk and Higher-Risk Patients Giving Birth at Rural and Urban US Hospitals. JAMA Health Forum 2023; 4:e232110. [PMID: 37354537 DOI: 10.1001/jamahealthforum.2023.2110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023] Open
Abstract
Importance Identifying hospital factors associated with severe maternal morbidity (SMM) is essential to clinical and policy efforts. Objective To assess associations between obstetric volume and SMM in rural and urban hospitals and examine whether these associations differ for low-risk and higher-risk patients. Design, Setting, and Participants This retrospective cross-sectional study of linked vital statistics and patient discharge data was conducted from 2022 to 2023. Live births and stillbirths (≥20 weeks' gestation) at hospitals in California (2004-2018), Michigan (2004-2020), Pennsylvania (2004-2014), and South Carolina (2004-2020) were included. Data were analyzed from December 2022 to May 2023. Exposures Annual birth volume categories (low, medium, medium-high, and high) for hospitals in urban (10-500, 501-1000, 1001-2000, and >2000) and rural (10-110, 111-240, 241-460, and >460) counties. Main Outcome and Measures The main outcome was SMM (excluding blood transfusion); covariates included age, payer status, educational attainment, race and ethnicity, and obstetric comorbidities. Analyses were stratified for low-risk and higher-risk obstetric patients based on presence of at least 1 clinical comorbidity. Results Among more than 11 million urban births and 519 953 rural births, rates of SMM ranged from 0.73% to 0.50% across urban hospital volume categories (high to low) and from 0.47% to 0.70% across rural hospital volume categories (high to low). Risk of SMM was elevated for patients who gave birth at rural hospitals with annual birth volume of 10 to 110 (adjusted risk ratio [ARR], 1.65; 95% CI, 1.14-2.39), 111 to 240 (ARR, 1.37; 95% CI, 1.10-1.70), and 241 to 460 (ARR, 1.26; 95% CI, 1.05-1.51), compared with rural hospitals with greater than 460 births. Increased risk of SMM occurred for low-risk and higher-risk obstetric patients who delivered at rural hospitals with lower birth volumes, with low-risk rural patients having notable discrepancies in SMM risk between low (ARR, 2.32; 95% CI, 1.32-4.07), medium (ARR, 1.66; 95% CI, 1.20-2.28), and medium-high (ARR, 1.68; 95% CI, 1.29-2.18) volume hospitals compared with high volume (>460 births) rural hospitals. Among hospitals in urban counties, there was no significant association between birth volume and SMM for low-risk or higher-risk obstetric patients. Conclusions and Relevance In this cross-sectional study of births in US rural and urban counties, risk of SMM was elevated for low-risk and higher-risk obstetric patients who gave birth in lower-volume hospitals in rural counties, compared with similar patients who gave birth at rural hospitals with greater than 460 annual births. These findings imply a need for tailored quality improvement strategies for lower volume hospitals in rural communities.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Stephanie A Leonard
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California
- California Maternal Quality Care Collaborative, Stanford
| | - Sara C Handley
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia
| | - Molly Passarella
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elliott K Main
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California
- California Maternal Quality Care Collaborative, Stanford
| | - Scott A Lorch
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia
| | - Ciaran S Phibbs
- Health Economics Resource Center, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California
- Departments of Pediatrics and Health Policy, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
9
|
Basile Ibrahim B, Kozhimannil KB. Racial Disparities in Respectful Maternity Care During Pregnancy and Birth After Cesarean in Rural United States. J Obstet Gynecol Neonatal Nurs 2023; 52:36-49. [PMID: 36400125 PMCID: PMC9839498 DOI: 10.1016/j.jogn.2022.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the experiences of pregnancy and birth after cesarean of women who live in rural areas of the United States, including access to vaginal birth after cesarean (VBAC), type of maternity care provider, travel times, autonomy in decision making, and respectful maternity care. DESIGN Retrospective observational study. SETTING Online questionnaire of women who gave birth in the United States. PARTICIPANTS Women (N = 1,711) with histories of cesarean and subsequent births within 5 years of participating. METHODS We calculated descriptive and bivariate statistics by identified areas of residence and stratified measures of autonomy and respectful maternity care by self-identification as a member of a racialized group. We applied qualitative descriptive analysis to responses to an open-ended survey question. RESULTS A total of 299 (17.5%) participants identified their areas of residence as rural. Similar percentages of rural and metropolitan participants were able to plan VBAC (p = .88). More rural participants than metropolitan participants reported travel times of more than 60 minutes to give birth (p < .001), and fewer had obstetricians (p = .002) or doulas (p = .03). Rural participants from racialized groups experienced significantly less respectful maternity care than White, non-Hispanic rural participants and all metropolitan participants (p = .04). Qualitative data illustrating the main findings are included. CONCLUSIONS Our findings highlight challenges faced by rural residents accessing VBAC and help explain why rates of VBAC in rural areas remain low. We suggest a range of clinical and policy strategies to improve access to VBAC in rural areas and to improve the quality of maternity care for racialized women who live in rural areas.
Collapse
|
10
|
Affiliation(s)
- Katy Backes Kozhimannil
- From the Center for Antiracism Research for Health Equity and the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Asha Hassan
- From the Center for Antiracism Research for Health Equity and the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Rachel R Hardeman
- From the Center for Antiracism Research for Health Equity and the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| |
Collapse
|
11
|
Henning-Smith C, Dill J, Baldomero A, Kozhimannil KB. Rural/urban differences in access to paid sick leave among full-time workers. J Rural Health 2022:10.1111/jrh.12703. [PMID: 35881497 PMCID: PMC9877243 DOI: 10.1111/jrh.12703] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE Access to paid sick leave is critically important to promoting good health, caregiving, and stopping the spread of disease. In this study, we estimate whether access to paid sick leave among US full-time workers differs between rural and urban residents. METHODS We used data from the 2020 National Health Interview Survey and included adult respondents between the ages of 18 and 64 who were employed full-time (n = 12,086). We estimated bivariate differences in access to paid sick leave by rural/urban residence, and then calculated the predicted probability of access to paid sick leave, adjusting for sociodemographic and health characteristics, across different education levels. FINDINGS We find a nearly 10-percentage point difference in access to paid sick leave between rural and urban adults (68.1% vs 77.1%, P<.001). The difference in access to paid sick leave between rural and urban residents remained significant even after adjusting for sociodemographic and health characteristics. The fully adjusted predicted probability of paid sick leave for rural full-time workers was 69.8%, compared with 76.4% for urban full-time workers (P<.001). We also identified lower levels of paid leave for rural (vs urban) workers within each educational category. CONCLUSIONS Full-time workers in rural areas have less access to paid sick leave than full-time workers in urban areas. Without access to paid sick leave, rural and urban residents may go to work while contagious or forego necessary health care. Left to individual employers or localities, rural inequities in access to paid sick leave will likely persist.
Collapse
Affiliation(s)
- Carrie Henning-Smith
- Division of Health Policy and Management, University of
Minnesota School of Public Health, Minneapolis, MN, USA
| | - Janette Dill
- Division of Health Policy and Management, University of
Minnesota School of Public Health, Minneapolis, MN, USA
| | - Arianne Baldomero
- Pulmonary, Allergy, Critical Care, and Sleep Medicine,
Minneapolis VA Health Care System, Minneapolis, MN, USA,Pulmonary, Allergy, Critical Care, and Sleep Medicine,
University of Minnesota Medical School, Minneapolis, MN, USA
| | - Katy Backes Kozhimannil
- Division of Health Policy and Management, University of
Minnesota School of Public Health, Minneapolis, MN, USA
| |
Collapse
|
12
|
Vyas AN, Katon JG, Battaglia TA, Batra P, Borkowski L, Frick KD, Hamilton AB, Agénor M, Amutah-Onukagha N, Bird CE, Kozhimannil KB, Lara-Cinisomo S. Advancing Health Equity through Inclusive and Equitable Publication Practices at Women's Health Issues. Womens Health Issues 2022. [DOI: 10.1016/j.whi.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Carroll C, Interrante JD, Daw JR, Kozhimannil KB. Association Between Medicaid Expansion And Closure Of Hospital-Based Obstetric Services. Health Aff (Millwood) 2022; 41:531-539. [PMID: 35377761 DOI: 10.1377/hlthaff.2021.01478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Access to obstetric services has declined steadily during the past decade, driven by the closure of hospital-based obstetric units and of entire hospitals. A fundamental challenge to maintaining obstetric services is that they are frequently unprofitable for hospitals to operate, threatening hospital viability. Medicaid expansion has emerged as a possible remedy for obstetric service closure because it reduces uncompensated care and improves hospital finances. Using national hospital data from the period 2010-18, we assessed the relationship between Medicaid expansion and obstetric service closure in rural and urban communities. We found that expansion led to a large reduction in hospital closures; however, this effect was concentrated among hospitals that did not have obstetric units. Considering closure of obstetric units, we found that rural obstetric units were less likely to close immediately after expansion, but this effect faded within two years. Overall, our findings suggest that Medicaid expansion had little effect on the closure of obstetric services. Policies supporting access to obstetric care may need to directly address the financial challenges specific to this service line.
Collapse
Affiliation(s)
- Caitlin Carroll
- Caitlin Carroll , University of Minnesota, Minneapolis, Minnesota
| | | | - Jamie R Daw
- Jamie R. Daw, Columbia University, New York, New York
| | | |
Collapse
|
14
|
Karbeah J, Hardeman R, Katz N, Orionzi D, Kozhimannil KB. From a Place of Love: The Experiences of Birthing in a Black-Owned Culturally-Centered Community Birth Center. J Health Dispar Res Pract 2022; 15:47-60. [PMID: 37275571 PMCID: PMC10237589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Introduction Racial and ethnic disparities in perinatal health outcomes are among the greatest threats to population health in the United States. Black birthing communities are most impacted by these inequities due to structural racism throughout society and within health care settings. Although multiple studies have shown that structural racism and the disrespect associated with this system of inequity are the root causes of observed perinatal inequities, little scholarship has centered the needs of Black birthing communities to create alternative care models. Leaning on reproductive justice and critical race theoretical frameworks, this study explores good birth experiences as described by Black birthing people. Methods Thematic analysis of two focus groups and three one-on-one interviews conducted with clients at a Black-owned free-standing culturally-centered birth center (n=10). Results We found that Black birthing persons' concerns centered on three main themes: agency, historically- and culturally-safe birthing experiences, and relationship-centered care. Many participants pointed directly to past experiences of medical mistreatment and obstetric racism when defining their ideal birth experience. Conclusion Black birthing people seeking care from culturally-informed providers often do so because they have been mistreated, disregarded, and neglected within traditional care settings. The needs articulated by our study participants provide a powerful framework for understanding alternative patient-centered models of care that can be developed to improve the care experiences of Black birthing people in the pursuit of birth equity.
Collapse
Affiliation(s)
- J'Mag Karbeah
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health
| | - Rachel Hardeman
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health
| | | | | | | |
Collapse
|
15
|
Admon LK, Dalton VK, Kolenic GE, Tilea A, Hall SV, Kozhimannil KB, Zivin K. Comparison of Delivery-Related, Early and Late Postpartum Severe Maternal Morbidity Among Individuals With Commercial Insurance in the US, 2016 to 2017. JAMA Netw Open 2021; 4:e2137716. [PMID: 34878553 PMCID: PMC8655600 DOI: 10.1001/jamanetworkopen.2021.37716] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study assesses the relative rates and characteristics of early and late postpartum severe maternal morbidity overall and among racial and ethnic groups and individuals with perinatal mood and anxiety disorder.
Collapse
Affiliation(s)
- Lindsay K. Admon
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Program on Women’s Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
| | - Vanessa K. Dalton
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Program on Women’s Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
| | - Giselle E. Kolenic
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
- Program on Women’s Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
| | - Anca Tilea
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
- Program on Women’s Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
| | - Stephanie V. Hall
- Program on Women’s Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor
| | - Katy Backes Kozhimannil
- Department of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Kara Zivin
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Program on Women’s Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
- Department of Health Policy and Management, University of Michigan School of Public Health, Ann Arbor
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| |
Collapse
|
16
|
Affiliation(s)
- Katy Backes Kozhimannil
- University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis
| | - Carrie Henning-Smith
- University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis
| |
Collapse
|
17
|
Admon LK, Daw JR, Winkelman TNA, Kozhimannil KB, Zivin K, Heisler M, Dalton VK. Insurance Coverage and Perinatal Health Care Use Among Low-Income Women in the US, 2015-2017. JAMA Netw Open 2021; 4:e2034549. [PMID: 33502480 PMCID: PMC7841453 DOI: 10.1001/jamanetworkopen.2020.34549] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study uses 2015-2017 data from the Pregnancy Risk Surveillance and Monitoring System to examine the association between health insurance coverage and use of perinatal health care among low-income women in the US.
Collapse
Affiliation(s)
- Lindsay K. Admon
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Jamie R. Daw
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York
| | - Tyler N. A. Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Katy Backes Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Kara Zivin
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Vanessa K. Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| |
Collapse
|
18
|
Kozhimannil KB. Keeping Rural Infants Alive: Combatting Structural Inequities. Pediatrics 2020; 146:peds.2020-025486. [PMID: 33077540 DOI: 10.1542/peds.2020-025486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota and Rural Health Research Center, University of Minnesota, Minneapolis
| |
Collapse
|
19
|
Bennett KJ, Borders TF, Holmes GM, Kozhimannil KB, Ziller E. What Is Rural? Challenges And Implications Of Definitions That Inadequately Encompass Rural People And Places. Health Aff (Millwood) 2020; 38:1985-1992. [PMID: 31794304 DOI: 10.1377/hlthaff.2019.00910] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Monitoring and improving rural health is challenging because of varied and conflicting concepts of just what rural means. Federal, state, and local agencies and data resources use different definitions, which may lead to confusion and inequity in the distribution of resources depending on the definition used. This article highlights how inconsistent definitions of rural may lead to measurement bias in research, the interpretation of research outcomes, and differential eligibility for rural-focused grants and other funding. We conclude by making specific recommendations on how policy makers and researchers could use these definitions more appropriately, along with definitions we propose, to better serve rural residents. We also describe concepts that may improve the definition of and frame the concept of rurality.
Collapse
Affiliation(s)
- Kevin J Bennett
- Kevin J. Bennett ( kevin. bennett@uscmed. sc. edu ) is an associate professor of family medicine and director of the Research Center for Transforming Health, both at the University of South Carolina School of Medicine, in Columbia
| | - Tyrone F Borders
- Tyrone F. Borders is a professor of health management and policy and the Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy, both at the University of Kentucky, in Lexington
| | - George M Holmes
- George M. Holmes is a professor in the Department of Health Policy and Management and director of the Cecil G. Sheps Center for Health Services Research, both at the University of North Carolina at Chapel Hill
| | - Katy Backes Kozhimannil
- Katy Backes Kozhimannil is an associate professor in the Division of Health Policy and Management, University of Minnesota School of Public Health, in Minneapolis
| | - Erika Ziller
- Erika Ziller is an assistant professor of public health and director of the Maine Rural Health Research Center, both at the University of Southern Maine, in Portland
| |
Collapse
|
20
|
Henning-Smith CE, Hernandez AM, Hardeman RR, Ramirez MR, Kozhimannil KB. Rural Counties With Majority Black Or Indigenous Populations Suffer The Highest Rates Of Premature Death In The US. Health Aff (Millwood) 2020; 38:2019-2026. [PMID: 31794313 DOI: 10.1377/hlthaff.2019.00847] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite well-documented health disparities by rurality and race/ethnicity, research investigating racial/ethnic health differences among US rural residents is limited. We used county-level data to measure and compare premature death rates in rural counties by each county's majority racial/ethnic group. Premature death rates were significantly higher in rural counties with a majority of non-Hispanic black or American Indian/Alaska Native (AI/AN) residents than in rural counties with a majority of non-Hispanic white residents. After we adjusted for community-level covariates, differences in premature death remained significant in counties with a majority of AI/AN residents but not those with a majority of non-Hispanic black residents. This study highlights the particular vulnerability of non-Hispanic black and AI/AN rural communities to high rates of premature mortality. Policies to improve rural health should focus on these racially diverse communities, addressing economic vitality and current and historical political context to mitigate health inequities and the harmful health effects of neglecting social determinants of health.
Collapse
Affiliation(s)
- Carrie E Henning-Smith
- Carrie E. Henning-Smith ( henn0329@umn. edu ) is an assistant professor in the Division of Health Policy and Management, University of Minnesota School of Public Health, in Minneapolis
| | - Ashley M Hernandez
- Ashley M. Hernandez is a PhD candidate in the Division of Environmental Health Sciences, University of Minnesota School of Public Health
| | - Rachel R Hardeman
- Rachel R. Hardeman is an assistant professor in the Division of Health Policy and Management, University of Minnesota School of Public Health
| | - Marizen R Ramirez
- Marizen R. Ramirez is an associate professor in the Division of Environmental Health Sciences, University of Minnesota School of Public Health
| | - Katy Backes Kozhimannil
- Katy Backes Kozhimannil is an associate professor in the Division of Health Policy and Management, University of Minnesota School of Public Health
| |
Collapse
|
21
|
Snowden JM, Osmundson SS, Kaufman M, Blauer Peterson C, Kozhimannil KB. Cesarean birth and maternal morbidity among Black women and White women after implementation of a blended payment policy. Health Serv Res 2020; 55:729-740. [PMID: 32677043 PMCID: PMC7518810 DOI: 10.1111/1475-6773.13319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To test whether Minnesota's blended payment policy had differential effects on cesarean use and maternal morbidity among black women and white women in Minnesota, as compared to six control states. DATA SOURCES/STUDY SETTING Claims data from births to Medicaid fee-for-service beneficiaries, 2006-2012, in Minnesota (policy state) and six control states (Wisconsin, Iowa, Illinois, Oregon, Idaho, and Montana). STUDY DESIGN The key study intervention was Minnesota's blended payment policy, which established one single payment rate for uncomplicated vaginal and cesarean births in 2009. The primary outcome was cesarean birth, and secondary outcomes were maternal morbidity (composite), postpartum hemorrhage, and chorioamnionitis. Policy effects were assessed using race-stratified comparative interrupted time series analysis. PRINCIPAL FINDINGS Following policy implementation, cesarean use decreased among both black and white women in Minnesota compared to control states; this decline was larger among black women (-2.88 percent 3-year cumulative decline, from a prepolicy cesarean rate of 22.2 percent) than among white women (-1.32 percent, P = .0013). Postpartum hemorrhage increased, with larger increases among black women (1.20 percent 3-year cumulative increase), compared with white women (0.48 percent, P < .001) in Minnesota compared with control states. CONCLUSIONS Policy-related declines in cesarean use after Minnesota's blended payment policy were larger in black women. Increases in postpartum hemorrhage signal potential unintended consequences of policy-related cesarean reduction.
Collapse
Affiliation(s)
- Jonathan M. Snowden
- School of Public HealthOregon Health and Science University / Portland State UniversityPortlandOR
| | - Sarah S. Osmundson
- Department of Obstetrics and GynecologyVanderbilt University Medical CenterNashvilleTN
| | - Menolly Kaufman
- School of Public HealthOregon Health and Science University / Portland State UniversityPortlandOR
| | - Cori Blauer Peterson
- Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisMN
| | - Katy Backes Kozhimannil
- Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisMN
| |
Collapse
|
22
|
Kozhimannil KB, Interrante JD, Henning-Smith C, Admon LK. Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007–15. Health Aff (Millwood) 2019; 38:2077-2085. [DOI: 10.1377/hlthaff.2019.00805] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Katy Backes Kozhimannil
- Katy Backes Kozhimannil is an associate professor in the Division of Health Policy and Management, University of Minnesota School of Public Health, in Minneapolis
| | - Julia D. Interrante
- Julia D. Interrante is a doctoral student in the Division of Health Policy and Management, University of Minnesota School of Public Health
| | - Carrie Henning-Smith
- Carrie Henning-Smith is an assistant professor in the Division of Health Policy and Management, University of Minnesota School of Public Health
| | - Lindsay K. Admon
- Lindsay K. Admon is an assistant professor in the Department of Obstetrics and Gynecology at the University of Michigan, in Ann Arbor
| |
Collapse
|
23
|
Abstract
OBJECTIVES Although a range of factors shapes health and well-being, institutionalized racism (societal allocation of privilege based on race) plays an important role in generating inequities by race. The goal of this analysis was to review the contemporary peer-reviewed public health literature from 2002-2015 to determine whether the concept of institutionalized racism was named (ie, explicitly mentioned) and whether it was a core concept in the article. METHODS We used a systematic literature review methodology to find articles from the top 50 highest-impact journals in each of 6 categories (249 journals in total) that most closely represented the public health field, were published during 2002-2015, were US focused, were indexed in PubMed/MEDLINE and/or Ovid/MEDLINE, and mentioned terms relating to institutionalized racism in their titles or abstracts. We analyzed the content of these articles for the use of related terms and concepts. RESULTS We found only 25 articles that named institutionalized racism in the title or abstract among all articles published in the public health literature during 2002-2015 in the 50 highest-impact journals and 6 categories representing the public health field in the United States. Institutionalized racism was a core concept in 16 of the 25 articles. CONCLUSIONS Although institutionalized racism is recognized as a fundamental cause of health inequities, it was not often explicitly named in the titles or abstracts of articles published in the public health literature during 2002-2015. Our results highlight the need to explicitly name institutionalized racism in articles in the public health literature and to make it a central concept in inequities research. More public health research on institutionalized racism could help efforts to overcome its substantial, longstanding effects on health and well-being.
Collapse
Affiliation(s)
- Rachel R. Hardeman
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Katy A. Murphy
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - J’Mag Karbeah
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Katy Backes Kozhimannil
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
24
|
Snowden JM, Kozhimannil KB, Muoto I, Caughey AB, McConnell KJ. A 'busy day' effect on perinatal complications of delivery on weekends: a retrospective cohort study. BMJ Qual Saf 2016; 26:e1. [PMID: 27472947 PMCID: PMC5244816 DOI: 10.1136/bmjqs-2016-005257] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 12/13/2022]
Abstract
Objective To evaluate whether busy days on a labour and delivery unit are associated with maternal and neonatal complications of childbirth in California hospitals, accounting for weekday/weekend births. Design This is a population-based retrospective cohort study. Setting Linked vital statistics/patient discharge data for California births between 2009 and 2010 from the Office of Statewide Health Planning and Development. Participants All singleton, cephalic, non-anomalous California births between 2009 and 2010 (N=724 967). Main outcomes The key exposure was high daily obstetric volume, defined as giving birth on a day when the number of births exceeded the hospital-specific 75th percentile of daily delivery volume. Outcomes were a range of maternal and neonatal complications. Results Several maternal and neonatal complications were increased on high-volume days and weekends following adjustment for maternal demographics, annual hospital birth volume and teaching hospital status. For example, compared with low-volume weekdays, the odds of Apgar <7 on low-volume weekend days and high-volume weekend days were 11% (adjusted OR (aOR) 1.11, CI 1.03 to 1.21) and 29% higher (aOR 1.29, CI 1.10 to 1.52), respectively. High volume was associated with increased odds of neonatal seizures on weekdays (aOR 1.33, CI 1.01 to 1.71) and haemorrhage on weekends (aOR 1.11, CI 1.01 to 1.22). After accounting for between-hospital variation, weekend delivery remained significantly associated with increased odds of Apgar score <7, neonatal intensive care unit admission, prolonged maternal length of stay and the odds of neonatal seizures remained increased on high-volume weekdays. Conclusions Our findings suggest that weekend delivery is a consistent risk factor for a range of perinatal complications and there may be variability in how well hospitals handle surges in volume.
Collapse
Affiliation(s)
- Jonathan M Snowden
- Department of Obstetrics & Gynecology/Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Katy Backes Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Ifeoma Muoto
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - K John McConnell
- Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
25
|
Kozhimannil KB, Hung P, Casey MM, Lorch SA. Factors associated with high-risk rural women giving birth in non-NICU hospital settings. J Perinatol 2016; 36:510-5. [PMID: 26890556 DOI: 10.1038/jp.2016.8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/08/2016] [Accepted: 01/15/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify risk factors for childbirth in a facility without neonatal intensive care unit (NICU) capacity among high-risk rural women. STUDY DESIGN Using data on all maternal hospitalizations for rural residents in nine states (2010, 2012), we performed logit regression, focusing on women with multiple gestation and preterm birth. We defined a 'local' hospital as any maternity hospital within 30 miles (or the nearest hospital). RESULTS Rural women with preterm births and multiple gestation pregnancies were less likely to give birth in a hospital with NICU capacity if no local hospital had this capacity. Adjusted odds of giving birth in a NICU hospital were lower among women ⩽age 20 (AOR 0.87 (95% CI 0.77, 0.98)), Medicaid beneficiaries (0.81 (0.75, 0.89)), uninsured women (0.44 (0.32, 0.61)) and black women (0.60 (0.50, 0.71)). CONCLUSIONS Among high-risk rural pregnant women without local NICU access, younger, low-income, and black women had lower odds of using NICU hospitals.
Collapse
Affiliation(s)
- K B Kozhimannil
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - P Hung
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - M M Casey
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - S A Lorch
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
26
|
Kozhimannil KB, Attanasio LB, Johnson PJ, Gjerdingen DK, McGovern PM. Employment during pregnancy and obstetric intervention without medical reason: labor induction and cesarean delivery. Womens Health Issues 2014; 24:469-76. [PMID: 25213740 DOI: 10.1016/j.whi.2014.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 04/05/2014] [Accepted: 06/23/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rising rates of labor induction and cesarean delivery, especially when used without a medical reason, have generated concern among clinicians, women, and policymakers. Whether employment status affects pregnant women's childbirth-related care is not known. We estimated the relationship between prenatal employment and obstetric procedures, distinguishing whether women reported that the induction or cesarean was performed for medical reasons. METHODS Using data from a nationally representative sample of women who gave birth in U.S. hospitals (n = 1,573), we used propensity score matching to reduce potential bias from nonrandom selection into employment. Outcomes were cesarean delivery and labor induction, with and without a self-reported medical reason. Exposure was prenatal employment status (full-time employment, not employed). We conducted separate analyses for unmatched and matched cohorts using multivariable regression models. FINDINGS There were no differences in labor induction based on employment status. In unmatched analyses, employed women had higher odds of cesarean delivery overall (adjusted odds ratio [AOR], 1.45; p = .046) and cesarean delivery without medical reason (AOR, 1.94; p = .024). Adding an interaction term between employment and college education revealed no effects on cesarean delivery without medical reason. There were no differences in cesarean delivery by employment status in the propensity score-matched analysis. CONCLUSIONS Full-time prenatal employment is associated with higher odds of cesarean delivery, but this association was not explained by socioeconomic status and no longer existed after accounting for sociodemographic differences by matching women employed full time with similar women not employed during pregnancy.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
| | - Laura B Attanasio
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | | | - Dwenda K Gjerdingen
- Department of Family Medicine and Community Health, University of Minnesota Medical School, St. Paul, Minnesota
| | - Patricia M McGovern
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
| |
Collapse
|
27
|
Abstract
Intimate partner violence (IPV) is a significant public health issue affecting around three million U.S. women during their lifetimes; this article provides guidance to policymakers on addressing IPV. In 2011, an Institute of Medicine panel recommended routine IPV screening for women and adolescents as part of comprehensive preventive care services, which is in conflict with the 2004 U.S. Preventive Services Task Force recommendations. The current evidence base for policymaking suffers weaknesses related to study design, which should be addressed in future research. Meanwhile, policymakers should consider available evidence in their settings, assess local needs, and make recommendations where appropriate.
Collapse
|
28
|
Thao V, Golberstein E, Thomas W, Kozhimannil KB, Mau LW, Preussler JM, Denzen E, Majhail NS. Variation in Inpatient Costs of Hematopoietic Cell Transplantation Among Transplant Centers in the United States. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
29
|
Kozhimannil KB, Law MR, Virnig BA. Cesarean delivery rates vary tenfold among US hospitals; reducing variation may address quality and cost issues. Health Aff (Millwood) 2014; 32:527-35. [PMID: 23459732 DOI: 10.1377/hlthaff.2012.1030] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteenfold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordinating maternity care, collecting and measuring more data, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA.
| | | | | |
Collapse
|
30
|
Abstract
OBJECTIVE The purpose of this study was to characterize the relationship between maternal depressive symptoms and employment and whether it is mediated by social support. METHODS We used data from a nationally representative sample of 700 US women who gave birth in 2005 and completed 2 surveys in the Listening to Mothers series, the first in early 2006, an average of 7.3 months postpartum, and the second an average of 13.4 months postpartum. A dichotomous measure of depressive symptoms was calculated from the 2-item Patient Health Questionnaire, and women reported their employment status and levels of social support from partners and others. We modeled the association between maternal employment and depressive symptoms using multivariate logistic regression, including social support and other control variables. RESULTS Maternal employment and high support from a nonpartner source were both independently associated with significantly lower odds of depressive symptoms (adjusted odds ratio [AOR], 0.35 and P = .011, and AOR, 0.40, P = .011, respectively). These relationships remained significant after controlling for mothers' baseline mental and physical health, babies' health, and demographic characteristics (AOR, 0.326 and P = .015, and AOR, 0.267 and P = .025, respectively). CONCLUSIONS Maternal employment and strong social support, particularly nonpartner support, were independently associated with fewer depressive symptoms. Clinicians should encourage mothers of young children who are at risk for depression to consider ways to optimize their employment circumstances and "other" social support.
Collapse
Affiliation(s)
- Dwenda Gjerdingen
- the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis; Medica Research Institute and Divisions of Environmental Health Sciences, Health Policy and Management, and Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | | | | | | | | |
Collapse
|
31
|
Kozhimannil KB, Virnig BA, Law MR. Cesarean sections: the authors reply. Health Aff (Millwood) 2013; 32:1171. [PMID: 23733993 DOI: 10.1377/hlthaff.2013.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
32
|
Kozhimannil KB, Attanasio LB, McGovern PM, Gjerdingen DK, Johnson PJ. Reevaluating the relationship between prenatal employment and birth outcomes: a policy-relevant application of propensity score matching. Womens Health Issues 2013; 23:e77-85. [PMID: 23266134 PMCID: PMC3596463 DOI: 10.1016/j.whi.2012.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prior research shows an association between prenatal employment characteristics and adverse birth outcomes, but suffers methodological challenges in disentangling women's employment choices from birth outcomes, and little U.S.-based prior research compares outcomes for employed women with those not employed. This study assessed the effect of prenatal employment status on birth outcomes. METHODS With data from the Listening to Mothers II survey, conducted among a nationally representative sample of women who delivered a singleton baby in a U.S. hospital in 2005 (n = 1,573), we used propensity score matching to reduce potential selection bias. Primary outcomes were low birth weight (<2,500 g) and preterm birth (gestational age <37 weeks). Exposure was prenatal employment status (full time, part time, not employed). We conducted separate outcomes analyses for each matched cohort using multivariable regression models. FINDINGS Comparing full-time employees with women who were not employed, full-time employment was not causally associated with preterm birth (adjusted odds ratio [AOR], 1.37; p = .47) or low birth weight (AOR, 0.73; p = .41). Results were similar comparing full- and part-time workers. Consistent with prior research, Black women, regardless of employment status, had increased odds of low birth weight compared with White women (AOR, 5.07; p = .002). CONCLUSIONS Prenatal employment does not independently contribute to preterm births or low birth weight after accounting for characteristics of women with different employment statuses. Efforts to improve birth outcomes should focus on the characteristics of pregnant women (employed or not) that render them vulnerable.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729, Minneapolis, MN 55455, Phone: 612-626-3812, Fax: 612-624-2196,
| | - Laura B. Attanasio
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729, Minneapolis, MN 55455, Phone: 612-626-3812, Fax: 612-624-2196,
| | - Patricia M. McGovern
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, 420 Delaware St. SE, Minneapolis, MN 55455, Phone: 612-625-7429, Fax: 612-626-0650,
| | - Dwenda K. Gjerdingen
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 580 Rice Street St. Paul, MN 55103, Phone: 651-227-6551,
| | - Pamela Jo Johnson
- Medica Research Institute, 301 Carlson Parkway, Mail Route CW295, Minnetonka, MN 55305, Phone: 952-992-2195,
| |
Collapse
|
33
|
Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O'Brien M. Doula care, birth outcomes, and costs among Medicaid beneficiaries. Am J Public Health 2013; 103:e113-21. [PMID: 23409910 DOI: 10.2105/ajph.2012.301201] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared childbirth-related outcomes for Medicaid recipients who received prenatal education and childbirth support from trained doulas with outcomes from a national sample of similar women and estimated potential cost savings. METHODS We calculated descriptive statistics for Medicaid-funded births nationally (from the 2009 Nationwide Inpatient Sample; n = 279,008) and births supported by doula care (n = 1079) in Minneapolis, Minnesota, in 2010 to 2012; used multivariate regression to estimate impacts of doula care; and modeled potential cost savings associated with reductions in cesarean delivery for doula-supported births. RESULTS The cesarean rate was 22.3% among doula-supported births and 31.5% among Medicaid beneficiaries nationally. The corresponding preterm birth rates were 6.1% and 7.3%, respectively. After control for clinical and sociodemographic factors, odds of cesarean delivery were 40.9% lower for doula-supported births (adjusted odds ratio = 0.59; P < .001). Potential cost savings to Medicaid programs associated with such cesarean rate reductions are substantial but depend on states' reimbursement rates, birth volume, and current cesarean rates. CONCLUSIONS State Medicaid programs should consider offering coverage for birth doulas to realize potential cost savings associated with reduced cesarean rates.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA.
| | | | | | | | | |
Collapse
|
34
|
Abstract
INTRODUCTION Health care needs of pregnant women are met by a variety of clinicians in a changing policy and practice environment. This study documents recent trends in types of clinicians providing care to pregnant women in the United States. METHODS We used a repeat cross-sectional design and data from the Integrated Health Interview Series (2000-2009), a nationally representative data set, for respondents who reported being pregnant at the time of the survey (N = 3204). Using longitudinal logistic regression models, we analyzed changes over time in pregnant women's reported use of care from 1) obstetrician-gynecologists; 2) midwives, nurse practitioners (NPs), or physician assistants (PAs); or 3) both an obstetrician-gynecologist and a midwife, NP, or PA. RESULTS The percentage of pregnant women who reported seeing an obstetrician-gynecologist (87%) remained steady from 2000 through 2009. After controlling for demographic and clinical variables, the percentage who reported receiving care from a midwife, NP, or PA increased 4% annually (yearly adjusted odds ratio [AOR] 1.04; P < .001), indicating a cumulative increase of 48% over the decade. The percentage of pregnant women who received care from both an obstetrician-gynecologist and a midwife, NP, or PA also increased (AOR 1.027; P < .001), for a cumulative increase of 30%. DISCUSSION The increasing role of midwives, NPs, and PAs in the provision of maternity care suggests changes in the perinatal workforce and practice models that may promote collaborative care and quality improvement. However, better data collection is required to gather detailed information on specific provider types, these trends, and their implications.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of PublicHealth, Minneapolis, MN55455, USA.
| | | | | |
Collapse
|
35
|
Kozhimannil KB, Abraham JM, Virnig BA. National Trends in Health Insurance Coverage of Pregnant and Reproductive-Age Women, 2000 to 2009. Womens Health Issues 2012; 22:e135-41. [DOI: 10.1016/j.whi.2011.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 12/12/2011] [Accepted: 12/13/2011] [Indexed: 11/15/2022]
|
36
|
Kozhimannil KB, Adams AS, Soumerai SB, Busch AB, Huskamp HA. New Jersey's efforts to improve postpartum depression care did not change treatment patterns for women on medicaid. Health Aff (Millwood) 2011; 30:293-301. [PMID: 21289351 DOI: 10.1377/hlthaff.2009.1075] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Identification and treatment of postpartum depression are the increasing focus of state and national legislation, including portions of the Affordable Care Act. Some state policies and proposals are modeled directly on programs in New Jersey, the first state to require universal screening for postpartum depression among mothers who recently delivered babies. We examined the impact of these policies on a particularly vulnerable population, Medicaid recipients, and found that neither the required screening nor the educational campaign that preceded it was associated with improved treatment initiation, follow-up, or continued care. We argue that New Jersey's policies, although well intentioned, were predicated on an inadequate base of evidence and that efforts should now be undertaken to build that base. We also argue that to improve detection and treatment, policy makers contemplating or implementing postpartum depression mandates should consider additional measures. These could include requiring mechanisms to monitor and enforce the screening requirement; paying providers to execute screening and follow-up; and preliminary testing of interventions before policy changes are enacted.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA.
| | | | | | | | | |
Collapse
|
37
|
Abstract
OBJECTIVE The goal of this study was to characterize racial-ethnic differences in mental health care utilization associated with postpartum depression in a multiethnic cohort of Medicaid recipients. METHODS In a retrospective cohort study, administrative claims data from New Jersey's Medicaid program were obtained for 29,601 women (13,001 whites, 13,416 blacks, and 3,184 Latinas) who delivered babies between July 2004 and October 2007. Racial-ethnic differences were estimated with logistic regression for initiation of antidepressant medication or outpatient mental health visits within six months of delivery, follow-up (a prescription refill or second visit), and continued mental health care (at least three visits or three filled antidepressant prescriptions within 120 days). RESULTS Nine percent (N=1,120) of white women initiated postpartum mental health care, compared with 4% (N=568) of black women and 5% (N=162) of Latinas. With analyses controlling for clinical factors, the odds of initiating treatment after delivery were significantly (p<.001) lower for blacks (adjusted odds ratio [AOR]=.43) and Latinas (AOR=.59) compared with whites. Among those who initiated treatment, blacks and Latinas were less likely than whites to receive follow-up treatment (blacks, AOR=.66, p<.001; Latinas, AOR=.67, p<.05) or continued care (blacks, AOR=.81, p=.069; Latinas, AOR=.67, p<.05). Among those who initiated antidepressant treatment, black women and Latinas were less likely than whites to refill a prescription. CONCLUSIONS There were significant racial-ethnic differences in depression-related mental health care after delivery. Suboptimal treatment was prevalent among all low-income women in the study. However, racial and ethnic disparities in the initiation and continuation of postpartum depression care were particularly troubling and warrant clinical and policy attention.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | | | | | | | | |
Collapse
|
38
|
Kozhimannil KB, Soumerai SB, Huskamp HA. Evidence For Postpartum Depression Screening: The Authors Reply. Health Aff (Millwood) 2011. [DOI: 10.1377/hlthaff.2011.0434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Stephen B. Soumerai
- Harvard Medical School and Harvard Pilgrim Health Care Institute Boston, Massachusetts
| | | |
Collapse
|
39
|
Abstract
OBJECTIVE The goal of this study was to characterize racial-ethnic differences in mental health care utilization associated with postpartum depression in a multiethnic cohort of Medicaid recipients. METHODS In a retrospective cohort study, administrative claims data from New Jersey's Medicaid program were obtained for 29,601 women (13,001 whites, 13,416 blacks, and 3,184 Latinas) who delivered babies between July 2004 and October 2007. Racial-ethnic differences were estimated with logistic regression for initiation of antidepressant medication or outpatient mental health visits within six months of delivery, follow-up (a prescription refill or second visit), and continued mental health care (at least three visits or three filled antidepressant prescriptions within 120 days). RESULTS Nine percent (N=1,120) of white women initiated postpartum mental health care, compared with 4% (N=568) of black women and 5% (N=162) of Latinas. With analyses controlling for clinical factors, the odds of initiating treatment after delivery were significantly (p<.001) lower for blacks (adjusted odds ratio [AOR]=.43) and Latinas (AOR=.59) compared with whites. Among those who initiated treatment, blacks and Latinas were less likely than whites to receive follow-up treatment (blacks, AOR=.66, p<.001; Latinas, AOR=.67, p<.05) or continued care (blacks, AOR=.81, p=.069; Latinas, AOR=.67, p<.05). Among those who initiated antidepressant treatment, black women and Latinas were less likely than whites to refill a prescription. CONCLUSIONS There were significant racial-ethnic differences in depression-related mental health care after delivery. Suboptimal treatment was prevalent among all low-income women in the study. However, racial and ethnic disparities in the initiation and continuation of postpartum depression care were particularly troubling and warrant clinical and policy attention.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | | | | | | | | |
Collapse
|
40
|
Kozhimannil KB, Huskamp HA, Graves AJ, Soumerai SB, Ross-Degnan D, Wharam JF. High-deductible health plans and costs and utilization of maternity care. Am J Manag Care 2011; 17:e17-e25. [PMID: 21485419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the impact of switching from an HMO to a high-deductible health plan on the costs and utilization of maternity care. STUDY DESIGN Pre–post design, with a control group. METHODS We compared 229 women who delivered babies before or after their employers mandated a switch from HMO coverage to a high-deductible health plan, with a control group of 2180 matched women who delivered babies while their employers remained in an HMO plan. Administrative claims from a large Massachusetts-based health insurance program were used in a difference-in-differences regression analysis. RESULTS Mean out-of-pocket maternity care costs for high-deductible group members increased from $356 for women who delivered before the insurance transition (n = 86) to $942 for women who delivered after the transition (n = 143), compared with a change from $262 (n = 711) to $282 (n = 1569) for HMO members, a relative increase of 106% (P <.001) for high-deductible members. Delivery after transition to a high-deductible plan was not associated with changes in the odds of receiving early prenatal care (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.32-3.19), recommended prenatal visits (OR, 1.64; 95% CI, 0.89-3.02), or postpartum care (OR, 0.74; 95% CI, 0.42-1.32). CONCLUSIONS Switching from an HMO to a high-deductible plan with exemptions for routine care increased out-of-pocket member costs for maternity care, but had no apparent adverse impacts on receipt of recommended prenatal and postpartum care.
Collapse
|
41
|
Kozhimannil KB, Valera MR, Adams AS, Ross-Degnan D. The population-level impacts of a national health insurance program and franchise midwife clinics on achievement of prenatal and delivery care standards in the Philippines. Health Policy 2009; 92:55-64. [PMID: 19327862 DOI: 10.1016/j.healthpol.2009.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 02/18/2009] [Accepted: 02/24/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Adequate prenatal and delivery care are vital components of successful maternal health care provision. Starting in 1998, two programs were widely expanded in the Philippines: a national health insurance program (PhilHealth); and a donor-funded franchise of midwife clinics (Well Family Midwife Clinics). This paper examines population-level impacts of these interventions on achievement of minimum standards for prenatal and delivery care. METHODS Data from two waves of the Demographic and Health Surveys, conducted before (1998) and after (2003) scale-up of the interventions, are employed in a pre/post-study design, using longitudinal multivariate logistic and linear regression models. RESULTS After controlling for demographic and socioeconomic characteristics, the PhilHealth insurance program scale-up was associated with increased odds of receiving at least four prenatal visits (OR 1.04 [95% CI 1.01-1.06]) and receiving a visit during the first trimester of pregnancy (OR 1.03 [95% CI 1.01-1.06]). Exposure to midwife clinics was not associated with significant changes in achievement of prenatal care standards. While both programs were associated with slight increases in the odds of delivery in a health facility, these increases were not statistically significant. CONCLUSIONS These results suggest that expansion of an insurance program with accreditation standards was associated with increases in achievement of minimal standards for prenatal care among women in the Philippines.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave, 6th Floor, Boston, MA 02215, United States.
| | | | | | | |
Collapse
|
42
|
Abstract
CONTEXT Perinatal depression affects at least 10% to 12% of new mothers, and diabetes complicates up to 9% of pregnancies. Prior research shows a higher rate of major depression among individuals with diabetes. OBJECTIVE To examine the association between diabetes and depression during pregnancy and the postpartum period among a sample of low-income women. DESIGN, SETTING, AND PATIENTS Retrospective cohort study using data from New Jersey's Medicaid administrative claims database of 11,024 women who gave birth between July 1, 2004, and September 30, 2006, and who were continuously enrolled in Medicaid for 6 months prior to delivery and 1 year after giving birth. MAIN OUTCOME MEASURES Multivariate logistic regression was used to assess the association between prepregnancy diabetes or gestational diabetes and perinatal depression. Depression was defined as an International Classification of Diseases, Ninth Revision, diagnosis for depression or a prescription drug claim for an antidepressant medication, and diabetes was defined as having a diabetes diagnosis or filling a prescription for a diabetes medication. Both measures were assessed during the 6 months prior to and up to 1 year following delivery. RESULTS In the sample of women who gave birth, 15.2% (n = 100) with prepregnancy or gestational diabetes and 8.5% (n = 886) without diabetes were depressed during pregnancy or postpartum. After adjusting for age, race, year of delivery, and gestational age at birth, women with diabetes compared with those without diabetes had nearly double the odds of experiencing depression during the perinatal period (odds ratio, 1.85; 95% confidence interval, 1.45-2.36). Women with diabetes and no prenatal indication of depression (n = 62, 9.6%) had higher odds than their counterparts without diabetes (n = 604, 5.9%) of receiving a postpartum depression diagnosis or taking an antidepressant medication in the year following delivery (odds ratio, 1.69; 95% confidence interval, 1.27-2.23). CONCLUSION Prepregnancy or gestational diabetes was independently associated with perinatal depression, including new onset of postpartum depression, in our sample of low-income new mothers.
Collapse
Affiliation(s)
- Katy Backes Kozhimannil
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusett, USA
| | | | | |
Collapse
|