Variations in Postpartum Readmission by Individual Race, Ethnicity, and Rurality in South Carolina

Area of Science:

• Public Health
• Health Disparities
• Maternal Health

Background:

• Racial and ethnic disparities in postpartum readmission (PPR) persist, disproportionately affecting non-Hispanic Black individuals.
• Postpartum readmissions are linked to mental health disorders (MHDs) and substance use disorders (SUDs).
• Access to care is a significant challenge in rural communities.

Purpose of the Study:

• To examine how individual residential rurality and race/ethnicity intersect to influence all-cause, MHD-related, and SUD-related PPR.
• To analyze these associations up to one year postpartum.

Main Methods:

• A statewide retrospective cohort study utilized linked birth certificate and all-payer hospital data.
• Included individuals aged 15-50 who gave birth in South Carolina between January 1, 2018, and December 31, 2021.
• Cox proportional hazards models were used to estimate adjusted hazard ratios for 1-year follow-up.

Main Results:

• Non-Hispanic Black individuals in urban areas had a higher risk of all-cause PPR compared to non-Hispanic White individuals.
• Hispanic individuals had a lower risk of all-cause PPR compared to non-Hispanic White individuals.
• Rural residence was associated with increased all-cause PPR but attenuated racial and ethnic disparities.

Conclusions:

• Racial and ethnic disparities in postpartum readmission are more pronounced in urban areas.
• Geographic context, specifically rurality, appears to modify these disparities.
• Findings suggest that interventions should consider the interplay of race, ethnicity, and geographic location.