A Systematic Review and Meta-analysis of Racial Disparities in Prenatal Care in California: How Much? Does Insurance Matter?

Ruwe, Mathilda; Capitman, John A.; Bengiamin, Marlene; Soto, Tonantzin

doi:10.1080/19371910903344217

Cited by 12 publications

(9 citation statements)

References 41 publications

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“…16,20–24 However, previous reports that examined Medicaid enrollment in marginalized populations relied on descriptive reports or studies from states other than Massachusetts; no previous large-scale quantitative evaluation of this issue was conducted in Massachusetts. Therefore, our study provides an important contribution to the limited research available.…”

Section: Discussionmentioning

confidence: 99%

“…16,20 Despite meeting the income eligibility criteria, many people living in poverty remain uninsured because they don’t know they are eligible, they don’t know how to obtain coverage, or they lack any form of identification. 21,22 Homeless adults are disproportionately affected by lack of insurance and are reportedly difficult to enroll in public insurance programs.…”

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confidence: 99%

“…16,20–24 Data from state programs such as MassHealth are useful in assessing whether these groups will benefit from Medicaid expansion to the same extent as other population groups or may be in need of targeted interventions to improve their access. We examined administrative data on admissions to substance abuse treatment programs from 1992 to 2009 to assess the uptake of Medicaid coverage by substance-abusing homeless adults after the implementation of MassHealth in 1997.…”

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confidence: 99%

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Medicaid Expansion Initiative in Massachusetts: Enrollment Among Substance-Abusing Homeless Adults

Zur

Mojtabai

2013

Am J Public Health

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Objectives We assessed whether homeless adults entering substance abuse treatment in Massachusetts were less likely than others to enroll in Medicaid after implementation of the MassHealth Medicaid expansion program in 1997. Methods We used interrupted time-series analysis in data on substance abuse treatment admissions from the Treatment Episode Data Set (1992–2009) to evaluate Medicaid coverage rates in Massachusetts and to identify whether trends differed between homeless and housed participants. We also compared Massachusetts data with data from 17 other states and the District of Columbia combined. Results The percentage of both homeless and housed people entering treatment with Medicaid increased approximately 21% after expansion (P = .01), with an average increase of 5.4% per year over 12 years (P = .01). The increase in coverage was specific to Massachusetts, providing evidence that the MassHealth policy was the cause of this increase. Conclusions Findings provide evidence in favor of state participation in the Medicaid expansion in January 2014 under the Affordable Care Act and suggest that hard-to-reach vulnerable groups such as substance-abusing homeless adults are as likely as other population groups to benefit from this policy.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Medicaid Expansion Initiative in Massachusetts: Enrollment Among Substance-Abusing Homeless Adults

Zur

Mojtabai

2013

Am J Public Health

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“…In principle, public health programs to ensure adequate prenatal and intrapartum care could prevent a substantial proportion of epilepsy arising from these causes. Some disparities in access to prenatal care persist even in HIC, indicating needs for program improvement . However, the unmet need for such programs is greatest in LMIC, where >80% of the world population resides and where there are marked inequalities in the distribution of health care resources within and among countries .…”

Section: Discussionmentioning

confidence: 99%

The primary prevention of epilepsy: A report of the Prevention Task Force of the International League Against Epilepsy

et al. 2018

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Among the causes of epilepsy are several that are currently preventable. In this review, we summarize the public health burden of epilepsy arising from such causes and suggest priorities for primary epilepsy prevention. We conducted a systematic review of published epidemiologic studies of epilepsy of 4 preventable etiologic categories-perinatal insults, traumatic brain injury (TBI), central nervous system (CNS) infection, and stroke. Applying consistent criteria, we assessed the quality of each study and extracted data on measures of risk from those with adequate quality ratings, summarizing findings across studies as medians and interquartile ranges. Among higher-quality population-based studies, the median prevalence of active epilepsy across all ages was 11.1 per 1000 population in lower- and middle-income countries (LMIC) and 7.0 per 1000 in high-income countries (HIC). Perinatal brain insults were the largest attributable fraction of preventable etiologies in children, with median estimated fractions of 17% in LMIC and 15% in HIC. Stroke was the most common preventable etiology among older adults with epilepsy, both in LMIC and in HIC, accounting for half or more of all new onset cases. TBI was the attributed cause in nearly 5% of epilepsy cases in HIC and LMIC. CNS infections were a more common attributed cause in LMIC, accounting for about 5% of all epilepsy cases. Among some rural LMIC communities, the median proportion of epilepsy cases attributable to endemic neurocysticercosis was 34%. A large proportion of the overall public health burden of epilepsy is attributable to preventable causes. The attributable fraction for perinatal causes, infections, TBI, and stroke in sum reaches nearly 25% in both LMIC and HIC. Public health interventions addressing maternal and child health care, immunizations, public sanitation, brain injury prevention, and stroke prevention have the potential to significantly reduce the burden of epilepsy.

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“…14 The Hispanic paradox of relatively good birth outcomes among poor Hispanic women further refutes SES as a singular explanation. 15,16 Additionally, although racial differences in prenatal care are documented, expansion of insurance coverage and greater rates of early prenatal care have not resulted in better birth outcomes for any group, 17-19 indicating that access to care alone will not resolve the disparities.…”

Section: Introductionmentioning

confidence: 99%

Maternal Differences and Birth Outcome Disparities: Diversity Within a High-Risk Prenatal Clinic

Thomas¹,

Spielvogel²,

Cohen³

et al. 2014

J. Racial and Ethnic Health Disparities

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Background We examined the influence of race/ethnicity on appointment attendance, maternal psychiatric and medical diagnoses, and birth outcomes within a diverse, low income, high risk pregnant population to determine whether birth outcome disparities would be lessened in a sample with high biopsychosocial risk across all groups Methods Data were retrospectively obtained on all women scheduled for appointments in the San Francisco Genera Hospital (SFGH) High-Risk Obstetrics (HROB) clinic during a three-month period. General linear model and logistic regression procedures were used to examine the associations of race/ethnicity with maternal characteristics, clinic attendance, and birth outcomes. Results Our sample included 202 maternal-infant pairs (Hispanic 57%, Black 16%, Asian 15%, White 12%). Racial/ethnic differences were seen in language (p < .001), gravidity (p < .001), parity (p = .005), appointment attendance (p < .001), diabetes (p = .005), psychiatric diagnosis (p = .02), illicit drug use (p < .001), smoking (p < .001). These maternal characteristics, including rate of attendance at specialized prenatal appointments, did not predict birth outcomes with the exception of an association between diabetes and earlier gestational age (p = .03). In contrast, Black maternal race/ethnicity was associated with earlier gestational age at birth (p = .004) and lower birth weight (p < .001) compared to Whites. Conclusions Within a diverse maternal population of high biopsychosocial risk, racial/ethnic disparities in birth outcomes persist. These disparities have implications for infant health trajectory throughout the lifecourse and for intervention implementation in high risk groups.

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A Systematic Review and Meta-analysis of Racial Disparities in Prenatal Care in California: How Much? Does Insurance Matter?

Cited by 12 publications

References 41 publications

Medicaid Expansion Initiative in Massachusetts: Enrollment Among Substance-Abusing Homeless Adults

Medicaid Expansion Initiative in Massachusetts: Enrollment Among Substance-Abusing Homeless Adults

The primary prevention of epilepsy: A report of the Prevention Task Force of the International League Against Epilepsy

Maternal Differences and Birth Outcome Disparities: Diversity Within a High-Risk Prenatal Clinic

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