Different levels of associations between medical co-morbidities and preterm birth outcomes among racial/ethnic women enrolled in Medicaid 2014–2015: retrospective analysis

Abstract

Background: The causes of preterm birth are multi-dimensional, including delayed and inadequate prenatal services as well as other medical and socioeconomic factors. This study aimed to examine the different levels of association between preterm birth and major medical co-morbidities among various racial/ethnic women enrolled in Medicaid. Methods: This is a retrospective analysis of 457,200 women aged between 15 and 44 with a single live birth from the IBM® MarketScan® Multi-State Medicaid Database from 2014 to 2015. Preterm birth, defined by delivery before 37 completed weeks of gestation, was the primary dependent variable. All births were dichotomously categorized as either preterm or full-term birth using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Independent variables included race/ethnicity, categorized as non-Hispanic white, non-Hispanic black, Hispanic, or other. Medical co-morbidities included smoking, drug dependence, alcohol dependence, diabetes, and hypertension. Total healthy prenatal visit count and high-risk prenatal visit encounters identified during 30 weeks prior to the delivery date were included in the analysis. Results: A significantly higher preterm birth rate was found in black women after controlled for medical comorbidities, age, prenatal visit count, and high-risk pregnancy. Different levels of association between preterm birth outcome and major medical co-morbidities were examined among various racial/ethnic women enrolled in Medicaid. Drug dependence was associated with higher odds of preterm birth in black (OR = 2.56, 95% CI [1.92-3.41]) and white women (OR = 2.12, 95% CI [1.91-2.34]), when controlled for other variables. In Hispanic women, diabetes (OR=1.44, 95% CI [1.27, 1.64]) and hypertension (OR=1.98, 95% CI [1.74, 2.26]) were associated with higher odds of preterm birth. White women diagnosed with drug dependence had a 14.0% predicted probability of preterm birth, whereas black women diagnosed with drug dependence had a predicted probability of preterm birth of 21.5%. Conclusions: The associations of medical co-morbidities and preterm births varied across racial and ethnic groups of women enrolled in Medicaid. This report calls for future research on racial/ethnic disparity in preterm birth to apply integrative and qualitative approaches to understand the disparity from a contextual perspective, especially for vulnerable pregnant women like Medicaid enrollees.

Comparison of the use of prenatal care services and the risk of preterm birth between pregnant women with disabilities and those without disabilities: A nationwide cohort study

“…Age, monthly salary, education level, and degree of urbanization of the area of residence did not significantly affect the proportion of preterm birth, reflected by the variation in the number of prenatal care services used. In the disabled group, women with more severe comorbidities had higher proportion of preterm birth than those with less severe comorbidities, which may be due to the poorer health condition of these women (38,39). Although a history of miscarriage increased the number of prenatal care services used during the current pregnancy, a history of miscarriage was associated with preterm birth.…”

Impact of Race/Ethnicity and Insurance Status on Obstetric Outcomes: Secondary Analysis of the NuMoM2b Study

“…2 Historically, Black and Hispanic individuals have health care delivery and disease outcomes that are disproportionate in comparison to White patients. 3,4 Health inequities in marginalized communities are often rooted in structural racism and social factors that include higher poverty and incarceration rates and decreased levels of health insurance in Hispanic or Latino, Black, and Native American or Alaska native compared with Whites. 5 Health inequity in minoritized populations has also been demonstrated in obstetric, [6][7][8][9][10][11][12][13][14] perinatal care, 15 and maternal and infant mortality.…”

Fatores de risco associados ao parto prematuro: estudo caso-controle

“…Um estudo de coorte realizado nos Estados Unidos coletou dados de mais de 400 mil mulheres que pariram entre os anos de 2014 e 2015 através do Medicaid (programa de saúde pública destinado a população de baixa renda nos Estados Unidos) e detectou que a taxa de nascimento prematuro entre as mulheres negras (9,9%) foi maior em comparação às mulheres brancas (7,3%) e hispânicas (6,2%) (LEE et al, 2020).…”

“…Sendo as chances de parto prematuro reduzidas em mulheres hispânicas (17%) se comparadas às mulheres brancas. Para aquelas mulheres com diagnóstico de dependência de drogas ou álcool as chances de parto prematuro eram equivalentes a mais que o dobro, além de também estar associado ao tabagismo, hipertensão e diabetes materna (LEE et al, 2020).…”

“…Um estudo realizado nos Estados Unidos das Américas (EUA) identificou que menos de um terço de mulheres cadastradas no programa de saúde pública de baixa renda do país que pariram no período de 2014 a 2018 realizaram 8 ou mais consultas de pré-natal. Mulheres com oito ou mais consultas pré-natais obtiveram uma diminuição na associação da probabilidade prevista de nascimento prematuro (resultando em uma redução de 12,2% para 6,4% em mulheres negras, de 8,3% para 5,3% em mulheres brancas e de 6,7% para 4,4% em mulheres hispânicas) (LEE et al, 2020).…”