Socioeconomic Disparities in Ectopic Pregnancy: Predictors of Adverse Outcomes from Illinois Hospital-Based Care, 2000–2006

Abstract

This study aimed to identify the incidence of adverse outcomes from ectopic pregnancy hospital care in Illinois (2000–2006), and assess patient, neighborhood, hospital and time factors associated with these outcomes. Discharge data from Illinois hospitals were retrospectively analyzed and ectopic pregnancies were identified using DRG and ICD-9 diagnosis codes. The primary outcome was any complication identified by ICD-9 procedure codes. Secondary outcomes were length of stay and discharge status. Residential zip codes were linked to 2000 U.S. Census data to identify patients’ neighborhood demographics. Logistic regression was used to identify risk factors for adverse outcomes. Independent variables were insurance status, age, co-morbidities, neighborhood demographics, hospital type, hospital ectopic pregnancy service volume, and year of discharge. Of 13,007 ectopic pregnancy hospitalizations, 7.4% involved at least one complication identified by procedure codes. Hospitalizations covered by Medicare (for women with chronic disabilities) were more likely than those with other source or without insurance to result in surgical sterilization (OR 4.7, P = 0.012). Hospitalization longer than 2 days was more likely with Medicaid (OR 1.46, P<0.0005) or no insurance (OR 1.35, P<0.0005) versus other payers, and among church-operated versus secular hospitals (OR 1.21, P<0.0005). Compared to public hospitals, private hospitals had lower rates of complications (OR 0.39, P< 0.0005) and of hospitalization longer than 2 days (OR 0.57, P<0.0005). With time, hospitalizations became shorter (OR 0.53, P<0.0005) and complication rates higher (OR 1.33, P = 0.024). Ectopic pregnancy patients with Medicaid, Medicare or no insurance, and those admitted to public or religious hospitals, were more likely to experience adverse outcomes.

Disparities in the management of ectopic pregnancy

“…18,19 Among Medicaid recipients in New York, California, and Illinois, the relative risk for ectopic pregnancy among black women was 1.26 compared to white women between 2000–2003. 20 Furthermore, the risk of death from ectopic pregnancy was 6.8 times higher for black women compared to white women during 2003–2007.…”

“…19 Using the Nationwide Inpatient Sample, Papillon-Smith and colleagues analyzed the treatment of 35,000 women with ectopic pregnancy. The investigators found that Asian/Pacific Islanders and those treated in rural hospitals were less likely to undergo non-surgical management.…”

Population-Based Ectopic Pregnancy Trends, 1993–2007

“…7–12 For example, Calderon et al reported an ectopic pregnancy rate in California of 11.2 per 1000 pregnancies during 1991–2000 7 , Sewell et al noted a rate in Maryland of 5.2 per 10 000 women aged 15–44 years between 1994 and 1999 10 , and Stulberg et al reported a rate of 5.4 per 10 000 women aged 13–50 years utilizing Illinois Hospital Association discharge data from 2000–2006. 11 …”

Ectopic pregnancy rates and racial disparities in the Medicaid population, 2004–2008

“…Medicaid is an important data source for maternal health epidemiology since it includes low-income women, a population at high risk for maternal morbidity and mortality (3, 10). We previously reported ectopic pregnancy rates among Medicaid beneficiaries in three large states – California (2.07% of all reported pregnancies), Illinois (2.43%), and New York (2.38%) – from 2000 through 2003 (6).…”