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Racial/Ethnic Disparities in Hospital Admission for Postpartum Depression
Abstract Number: F310-324
Abstract Type: Original Research
Postpartum depression (PD) affects 13% women within 12 months after delivery (1). Although racial/ethnic differences have been reported for adverse pregnancy outcomes (e.g. pre-eclampsia, preterm birth), it is unclear whether the incidence of PD varies by race or ethnicity. Understanding racial disparities is important for identifying a high risk cohort that would benefit from early diagnosis and therapy.
We performed a retrospective population-based cohort study of primiparous women who underwent postpartum hospitalization for PD in California between 2008 and 2012. PD was identified by the presence of ICD-9-CM codes for depression (296.2x, 296.3x, 296.82, 296.90, 300.4, 309.0, 309.1, 309.28, 311) associated with a postpartum hospitalization upto 9 months after delivery. Race and ethnicity data were sourced from linked birth records or maternal discharge data. The cumulative incidence of PD was calculated by race/ethnicity (five groups: non-Hispanic White (NHW); non-Hispanic Black (NHB); Hispanic; Non-Hispanic Asian (NHA); and others). Incidences were calculated for women with a principal diagnosis of PD. Logistic regression was used to examine the risk of PD in racial/ethnic minority women compared to NHW. Sensitivity analysis was performed with PD identified as a principal or secondary diagnosis.
Our study cohort comprises 984,167 delivery hospitalizations. The overall cumulative incidences for postpartum hospitalization with PD as a principal diagnosis only and PD as a principal or secondary diagnosis were 15.9 and 53.6 per 10,000 deliveries respectively. Cumulative incidences according to race/ethnicity are presented in Table 1. Compared to NHW women, NHB women had the highest risk (38.8 in 10,000 women) and NHA women had the lowest risk (6.6 in 10,000 women) of hospital admission for PD as a principal diagnosis. In our sensitivity analysis, the risk of PD was increased but to a lesser extent for NHB women compared to NHW women (Table 1).
Our findings suggest that racial/ethnic disparities exist in the risk of postpartum admission for PD, with NHB women incurring the highest risk. Further research is required to elucidate the psychosocial, environmental and medical factors that explain the elevated risk of PD admission in NHB women and the reduced risk of PD admission in NHA and Hispanic women.
Reference: (1) AHRQ No.05-E006-2.