Disparities in Obstetric Readmissions: A Multistate Analysis, 2007-2014

Area of Science:

• Reproductive Health
• Health Disparities
• Social Determinants of Health

Background:

• Hospital readmissions are a significant concern, disproportionately affecting racial-ethnic minorities and lower socioeconomic status populations.
• Existing research on readmission disparities has not extensively focused on the obstetric population.
• Understanding social determinants of health is crucial for addressing inequities in postpartum care.

Purpose of the Study:

• To investigate 30-day postpartum readmission rates.
• To analyze the independent and interactive effects of race ethnicity, primary insurance payer, and median income on obstetric readmissions.
• To identify specific patient-level social determinants contributing to readmission risk.

Main Methods:

• Utilized state inpatient databases from the Health Care Cost and Utilization Project (2007-2014) for all deliveries.
• Employed generalized linear mixed models (GLMMs) to estimate the impact of social determinants on readmission odds, controlling for confounders.
• Incorporated interaction terms within GLMMs to explore combined effects of social factors on postpartum readmissions.

Main Results:

• A total of 5,129,867 deliveries resulted in 79,260 (1.5%) 30-day readmissions.
• Black and Hispanic patients exhibited higher readmission rates compared to White patients (p < 0.001 and p < 0.05, respectively).
• Government-insured patients and those in the second income quartile showed increased readmission likelihood. Black patients with Medicare had a 2.78-fold increased risk (aOR 2.78), and the wealthiest Black patients had a 1.48-fold increased risk (aOR 1.48) compared to White patients.

Conclusions:

• Significant racial-ethnic disparities persist in obstetric readmissions.
• Black patients, particularly those with government insurance or in higher income quartiles, face elevated readmission risks.
• These findings underscore the need for targeted interventions to address social determinants of health in postpartum care.