Title: Are birth outcomes of mothers insured by Medicaid equivalent to those with private insurance when accounting for social determinants of health
Background: Health insurance status is associated with use of preventative healthcare services, correlating with improved baseline health. However, data on birth outcomes, as a function of health insurance type is mixed & has not accounted for social determinants of health (SDH).
Objectives: To determine the association between maternal health insurance type & birth outcomes, including prematurity(<37 wks. gestation), small for gestational age (SGA), NICU admission[among term, appropriate for gestational age (AGA) births] & composite birth outcomes [CBO (defined as any NICU admission, SGA or prematurity)]
Design/Methods: Cross sectional study of maternal surveys merged with electronic birth certificate data of singleton live births in NY. Health insurance type was defined as either Medicaid [M (including Children's Health Insurance Program)] vs private insurance (PI). Maternal characteristics included demographics, adverse life events [ALE (≥3 positive responses to SDH screening questions)], lifestyle behaviors & pregnancy history. Logistic regression assessed associations with maternal insurance type adjusting for self-reported race, education, marital status, foreign born, exercise (≥3 d/wks.), prenatal care, ALE, high risk pregnancy (defined as comorbidities or extremes of age), substance use before or during pregnancy & delivery mode.
Results: A total of 1015 mothers [M= 631, PI= 384) were analyzed. PI mothers, compared to those in M, had significant differences in race (White 60% v 23%, Blacks 12% v 21%, Hispanics 20% v 51% respectively). Mothers with PI had higher education, regular exercise &marriage (p's<0.05). M mothers had higher rates of foreign birth (p<0.001). NICU admissions and composite birth outcomes were significantly higher in M mothers. Adjusting for covariates, M mothers in comparison to PI mothers, had higher odds of term/AGA NICU admission (OR 1.99, 95% CI 1.06-3.7) & CBO (OR 1.7, 95% CI 1.1-2.6). Odds of delivering a preterm or SGA infant did not differ by insurance type.
Conclusions: M mothers were as likely as PI mothers to deliver a preterm or SGA infant, yet controlling for SDH, Medicaid remains associated with higher rates of NICU admission in the Term/AGA population, suggesting a risk of higher acuity. Taking policy steps to equate Medicaid and private insurance may help mitigate the observed difference in birth outcomes.
