Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome

Gadson, Alexis K.; Akpovi, Eloho; Mehta, Pooja

doi:10.1053/j.semperi.2017.04.008

Cited by 241 publications

(201 citation statements)

References 90 publications

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“…Our hypothesis was that spina bifida would be more strongly affected by neighborhood advantage among non‐Hispanic white women compared to Hispanic women. It is important to distinguish the association between neighborhood disadvantage and advantage by racial/ethnic groups not only because health protective behaviors (e.g., prenatal care and folic acid uptake) are not homogenous across groups, but also because social and structural factors thought to place individuals at increased risk vary by race/ethnicity (Dowd & Aiello, ; Gadson, Akpovi, & Mehta, ; Williams & Collins, ).…”

Section: Introductionmentioning

confidence: 99%

Understanding how the concentration of neighborhood advantage and disadvantage affects spina bifida risk among births to non‐Hispanic white and Hispanic women, Texas, 1999–2014

Shumate

Hoyt

Liu

et al. 2018

Birth Defects Research

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Section: Introductionmentioning

confidence: 99%

Understanding how the concentration of neighborhood advantage and disadvantage affects spina bifida risk among births to non‐Hispanic white and Hispanic women, Texas, 1999–2014

Shumate

Hoyt

Liu

et al. 2018

Birth Defects Research

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“…Birth outcomes are different among Hispanic women with different length of immigration years [23]. Risk behaviors like drug dependence and chronic medical conditions such as diabetes and hypertension often coincide with other medical and socioeconomic vulnerabilities and cultural contexts [1,8]. Contextual factors, such as distressed neighborhood, thought to explain up to two-thirds of racial disparity in the preterm birth rate among black and white women [8,24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Maternal age (both young and advanced at conception), history of smoking, substance abuse, obstetrical history, diabetes, and hypertension are common risk factors for preterm birth [1,[3][4][5][6]. The timing of initiation and frequency of prenatal care, often measured by the Kotelchuck or Kessner Index, were found to be significantly associated with preterm birth outcomes [7][8][9]. Adequate prenatal care can assess a woman's health and support for recommended care while reducing risky behaviors [10].…”

Section: Introductionmentioning

confidence: 99%

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

Lee

Okunev

Tranby

et al. 2020

BMC Pregnancy Childbirth

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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.

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“…It has been well-established that disparities in both accessibility and acceptability of prenatal care independently affect African American or Black women when compared with other low-income women in the United States (Bryant et al, 2010; Tucker Edmonds et al, 2015). Aspects of care such as health system trust and perceived racism, in addition to social determinants of health and differences in health status, have been implicated in these disparities (Attanasio & Kozhimannil, 2015; Gadson, Akpovi, & Mehta, 2016). Given our study population's composition of 95% self-identification as African American or Black, our findings may not be generalizable to all low-income or Medicaid-insured women seeking scheduled prenatal or unscheduled obstetric care.…”

Section: Discussionmentioning

confidence: 99%

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status

Mehta

Carter

Vinoya

et al. 2017

Women's Health Issues

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Background Pregnant high utilizers of unscheduled care may be at particular risk for poor perinatal outcomes, but the drivers of this association have not been explored from the patient perspective. Purpose We sought to understand maternal preference for unscheduled hospital-based obstetric care to inform interventions and improve value of publicly funded care during pregnancy. Methods We conducted a comparative qualitative analysis of in-depth semistructured interviews. Low-income pregnant women presenting to an inner city hospital-based obstetric triage unit were purposively sampled, categorized as either high or low utilizers of unscheduled care, and interviewed about challenges faced in obtaining pregnancy care and reasons for choosing between unscheduled versus scheduled care delivery. Results Demographically, high utilizers were similar to low utilizers, but were more likely to report adverse childhood experiences (p = .01). All 40 participants reported resource constraints and perceived hospital-based unscheduled obstetric care to be more accessible than outpatient prenatal care. Beyond this, high (n = 20) and low (n = 20) utilizer narratives differed significantly. Two distinct high utilizer profiles emerged. Some high utilizers repetitively used unscheduled hospital-based services owing to psychosocial determinants. Other high utilizing participants were driven by severe experiences of illness insufficiently addressed by outpatient prenatal care. Low utilizer narratives demonstrated high self-efficacy and social support compared with high utilizers. Conclusions Low-value, unscheduled, hospital-based care utilization by pregnant women of low socioeconomic status was driven by unmet clinical and psychosocial need. Implications for Policy and/or Practice Tailored community-focused innovations that use unscheduled visits as signals of risk may improve value of both outpatient and inpatient maternity care and better address adverse perinatal outcomes in vulnerable subgroups.

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Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome

Cited by 241 publications

References 90 publications

Understanding how the concentration of neighborhood advantage and disadvantage affects spina bifida risk among births to non‐Hispanic white and Hispanic women, Texas, 1999–2014

Understanding how the concentration of neighborhood advantage and disadvantage affects spina bifida risk among births to non‐Hispanic white and Hispanic women, Texas, 1999–2014

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

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status

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