1. Acute health care utilization in the first 24 months postpartum by rurality and pregnancy complications: A prospective cohort study
- Author
-
Ahrens, Katherine A., Palmsten, Kristin, Grantham, Charlie O., Lipkind, Heather S., and M. Ackerman-Banks, Christina
- Subjects
Medical care -- Utilization ,Women -- Health aspects ,Postnatal care -- Methods ,Pregnancy, Complications of -- Analysis ,Rural health ,Business ,Health care industry - Abstract
Objective: To estimate the rate of acute health care use (hospitalizations and emergency department [ED] visits) among postpartum persons by rurality of residence and pregnancy complications. Data Sources and Study Setting: 2006-2021 data from the Maine Health Data Organization's All Payer Claims Data. Study Design: We estimated the rates of hospitalizations and ED visits during the first 24 months postpartum, separately, overall and by four-level rurality of residence (urban, large rural, small rural, and isolated rural) and by pregnancy complications (prenatal depression, hypertensive disorders of pregnancy [HDP], and gestational diabetes mellitus [GDM]). We used Poisson regression models, adjusting for potential confounders. Data were weighted to account for censoring before 24 months postpartum. Data Extraction Methods: Deliveries during 2007-2019 (n = 122,412). Principal Findings: Approximately 4% of persons had at least one hospitalization within 24 months postpartum (mean monthly rate per 100 deliveries = 0.35). Adjusted rates were not different by rurality. Persons with prenatal depression (adjusted rate ratio [aRR] = 1.9; 95% confidence interval [CI] 1.5-2.5), HDP (aRR = 1.4; 1.0-2.0), and GDM (aRR = 1.4; 0.9-2.0) had higher hospitalization rates than those without these conditions. Approximately 44% of persons had at least one ED visit within 24 months postpartum (mean monthly rate per 100 deliveries = 5.4). Adjusted ED rates were higher for persons living in small rural areas as compared with urban areas (aRR = 1.3; 1.2-1.4). Persons with prenatal depression (aRR = 1.8; 1.7-1.9), HDP (aRR = 1.1; 1.0-1.2), and GDM (aRR = 1.3; 1.2-1.4) had higher ED rates than those without these conditions; ED rates were highest among those living in small rural areas. Conclusion: New policies and care practices may be needed to prevent acute health care encounters in the first 24 months after delivery for persons with common pregnancy conditions. Efforts to identify why postpartum people living in small rural areas have higher rates of ED visits are warranted. KEYWORDS emergency department, gestational diabetes, hospitalization, hypertensive disorders of pregnancy, perinatal depression, rural What is known on this topic * Acute health care use (emergency department visits and hospitalizations) is elevated for women in the first year postpartum compared with nonpregnant women, especially after a complicated pregnancy. * Women living in rural areas of the United States have higher rates of emergency department use. What this study adds * Acute health care use in the first 2 years postpartum is higher for women with prenatal depression, hypertensive disorders of pregnancy, and gestational diabetes compared with those without these conditions. * Women with prenatal depression have nearly twice the rate of acute health care use in the first 2 years postpartum as compared with women without prenatal depression. * Women living in small rural areas have approximately 30% higher emergency department visit rates in the first 2 years postpartum compared with those living in urban or other rural areas., 1 | INTRODUCTION Acute health care utilization (hospitalizations and emergency department [ED] visits) is elevated in the first year postpartum. (1) This is due to higher health care needs during [...]
- Published
- 2024
- Full Text
- View/download PDF