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Social determinants of health and their association with postpartum readmissions in patients with preeclampsia: a multi-state analysis, 2007-2014
Abstract Number: F3D-104
Abstract Type: Original Research
Postpartum hospital readmissions lead to disruptions in childcare and early parenting, cause a significant emotional and societal burden, and are costly to the healthcare system.(1) In addition to delivery-related factors such as cesarean delivery, risk factors for postpartum readmission include maternal comorbidities such as hypertension, for which women with preeclampsia are at highest risk. (2) Certain social determinants of health are associated with increased readmission in postpartum patients, and understanding these is important for the development of postpartum readmission prevention programs.
Although socioeconomic, racial, and ethnic disparities are known to exist in postpartum readmissions, no study has specifically investigated these disparities among patients with preexisting preeclampsia. (3) Therefore we sought to replicate the findings of previous studies on the effects of social determinants of health on postpartum readmissions, as well as within a subpopulation of those with a present-on-admission diagnosis of preeclampsia.
We conducted a retrospective (2007-2014) analysis of all singleton deliveries in Florida, California, New York, and Maryland from the State Inpatient Databases, Healthcare Cost and Utilization Project. A total of 4,999,993 patients were included in our analysis, of which 182,651 had a present-on-admission diagnosis of preeclampsia. Our primary outcome was readmission up to 30 days after delivery. Among all postpartum patients and in subgroup analyses for preeclampsia patients only, readmission rates were higher for black patients, patients residing in the poorest quartile of median income, and patients with public insurance. After adjustment for patient and hospital-level factors, patients with preeclampsia insured by public insurance—either Medicare or Medicaid—were 105% and 23% more likely of being readmitted up to 30 days when compared to private insurance, respectively (Medicare OR: 2.05, 95% CI: 1.69-2.49; Medicaid OR: 1.23, 95% CI: 1.16-1.31). Preeclamptic patients with other insurance (OR: 1.21, 95% CI: 1.02-1.44) and patients without insurance (OR: 1.21, 95% CI: 1.03-1.42) were also more likely to be readmitted up to 30 days when compared to patients with private insurance. Black patients with preeclampsia were about 20% more likely to be readmitted up to 30 days post-delivery than white patients with preeclampsia (OR: 1.22, 95% CI: 1.14-1.31).
Our study found that social determinants of health are associated with postpartum readmissions, even among a high-risk preeclamptic population. Future research should elucidate potential interconnected relationships between social determinants of health in patients with preeclampsia.
1. Aseltine RH, et al. Obstet Gynecol. 2015;126(5):1040-
2. Mogos MF, et al. J Hypertens. 2018;36(3):608-18.
3. Clapp MA, et al. Am J Obstet Gynecol. 2016;215(1):113 e1- e10.