Are birth outcomes of mothers insured by Medicaid equivalent to those with private insurance when accounting for social determinants of health

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ESPR238
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Abstract: :

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.

Prof
,
NYMC
Regional Perinatal Center, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla,New York
Maria Fareri Children's Hospital, Westchester Medical Center
Regional Perinatal Center, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, New York
Jersey Shore University Medical Center - a University level affiliate of Rutgers Robert Wood Johnson, Neptune, NJ, United States.
Regional Perinatal Center, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, New York

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