Medicaid and Preterm Birth and Low Birth Weight: The Last Two Decades

Anum, Emmanuel A.; Retchin, Sheldon M.; Strauss, Jerome F.

doi:10.1089/jwh.2009.1602

Cited by 37 publications

(26 citation statements)

References 44 publications

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“…According to the Centers for Medicare and Medicaid Services, Medicaid finances more than one-third of all births in the country [10], and these low-income women and children are at higher risk of pregnancy complications than women with commercial insurance. While adverse pregnancy outcomes have been studied among Medicaid enrollees [11–13], there are few studies regarding Medicaid costs generated by racial disparities in adverse outcomes of childbirth and pregnancy. Variations in outcomes are a significant public health concern, but also pose an economic burden [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Economic and Clinical Outcomes of Pregnancy Among Medicaid Recipients

Zhang

Cardarelli

Shim

et al. 2012

Matern Child Health J

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To explore racial-ethnic disparities in adverse pregnancy outcomes among Medicaid recipients, and to estimate excess Medicaid costs associated with the disparities. Cross-sectional study of adverse pregnancy outcomes and Medicaid payments using data from Medicaid Analytic eXtract files on all Medicaid enrollees in fourteen southern states. Compared to other racial and ethnic groups, African American women tended to be younger, more likely to have a Cesarean section, to stay longer in the hospital and to incur higher Medicaid costs. African-American women were also more likely to experience preeclampsia, placental abruption, preterm birth, small birth size for gestational age, and fetal death/stillbirth. Eliminating racial disparities in adverse pregnancy outcomes (not counting infant costs), could generate Medicaid cost savings of $114 to $214 million per year in these 14 states. Despite having the same insurance coverage and meeting the same poverty guidelines for Medicaid eligibility, African American women have a higher rate of adverse pregnancy outcomes than White or Hispanic women. Racial disparities in adverse pregnancy outcomes not only represent potentially preventable human suffering, but also avoidable economic costs. There is a significant financial return-on-investment opportunity tied to eliminating racial disparities in birth outcomes. With the Affordable Care Act expansion of Medicaid coverage for the year 2014, Medicaid could be powerful public health tool for improving pregnancy outcomes.

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Section: Introductionmentioning

confidence: 99%

Racial Disparities in Economic and Clinical Outcomes of Pregnancy Among Medicaid Recipients

Zhang

Cardarelli

Shim

et al. 2012

Matern Child Health J

View full text Add to dashboard Cite

show abstract

“…However, a recent literature review of studies of birth outcomes for women on Medicaid concluded that insurance by Medicaid itself was not associated with the likelihood of a preterm or low birth weight birth, once other risk factors are taken into account. 13 It is possible, however, that within the sub-group of infants born prematurely or at low birth weights, Medicaid insurance is a marker for factors that may increase infant mortality.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Effect of Hospital and Insurance Type on the Risk of 1-year Mortality of Very Low Birth Weight Infants

et al. 2012

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OBJECTIVES We examined the effect of hospital type and medical coverage on the risk of 1-year mortality of very low birth weight (VLBW) infants while adjusting for possible selection bias. METHODS The study population was limited to singleton live birth infants having birth weight between 500 and 1,500 grams with no congenital anomalies who were born in Arkansas hospitals between 2001 and 2007. Propensity score (PS) matching and PS covariate adjustment were used to mitigate selection bias. Additionally, a conventional multivariable logistic regression model was used for comparison purposes. RESULTS Generally, all three analytical approaches provided consistent results in terms of the estimated relative risk, absolute risk reduction, and the number needed to treat (NNT). Using the PS matching method, VLBW infants delivered at a hospital with a neonatal intensive care unit (NICU) were associated with a 35% relative decrease (95% bootstrap CI: 18.5% – 48.9%) in the risk of 1-year mortality as compared to those infants delivered at non-NICU hospitals. Furthermore, our results showed that on average, 16 VLBW infants (95% bootstrap CI: 11 – 32), would need to be delivered at a hospital with an NICU to prevent one additional death at one year. However, there was not a difference in the risk of 1-year mortality between VLBW infants born to Medicaid-insured versus non-Medicaid-insured women. CONCLUSIONS Estimated relative risk of infant mortality was significantly lower for births that occurred in hospitals with an NICU; therefore, greater efforts should be made to deliver VLBW neonates in an NICU hospital.

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“…A recent article called for a critical evaluation of programs to reduce prematurity and low birth weight among Medicaid recipients as a key factor in improving the status of this population. 20 The provision of evidence-based cessation services for pregnant smokers is clearly one component of such a program.…”

Section: Introductionmentioning

confidence: 99%

The Pittsburgh STOP Program: Disseminating an Evidence-Informed Intervention for Low-Income Pregnant Smokers

2011

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Purpose Prenatal smoking is a preventable risk factor for poor perinatal outcomes and is more prevalent in pregnant smokers of low socioeconomic status (SES). We describe the intervention model and factors associated with quitting from the Pittsburgh STOP Program, an evidence-informed dissemination intervention for low-SES pregnant smokers. Setting STOP is delivered in community health care clinics serving economically disadvantaged women. Participants Participants were 856 pregnant women who were current smokers (93%) and recent quitters (7%). Most were white (59%) or black (35%), single (74%), young (mean age = 25), and experiencing an unplanned pregnancy (84%); 90% were insured by Medicaid/uninsured. Methods An evidence-informed intervention for community pregnant women was delivered individually in a single-group pre-post evaluation design. Measures were demographics, participation and retention, smoking status, satisfaction, and cost. Analyses included descriptive statistics and logistic regression. Results Participants attended an average of 4.7 sessions. Dropout rate after the first session was 5%. Over 11% of smokers quit; 48% of preenrollment spontaneous quitters remained abstinent. Factors significantly associated with quitting included race, mother’s age, nicotine dependence, and number of sessions attended. Limitations STOP is a community program with self-selected participants and no control group. Conclusion Low-income pregnant smokers will engage in an evidence-informed cessation program tailored for this group, with quit rates that compare to controlled research results.

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Medicaid and Preterm Birth and Low Birth Weight: The Last Two Decades

Cited by 37 publications

References 44 publications

Racial Disparities in Economic and Clinical Outcomes of Pregnancy Among Medicaid Recipients

Racial Disparities in Economic and Clinical Outcomes of Pregnancy Among Medicaid Recipients

Evaluating the Effect of Hospital and Insurance Type on the Risk of 1-year Mortality of Very Low Birth Weight Infants

The Pittsburgh STOP Program: Disseminating an Evidence-Informed Intervention for Low-Income Pregnant Smokers

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