(1072) The Association of State Level Lack of Health Insurance and the Likelihood of Low Birthweight

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Although Medicaid expansion has not been associated with reductions in state low birth weight (LBW) rates, the association of state-level lack of health insurance with LBW is understudied. Given the relevance of state health care policies for birth outcomes, we aimed to examine the association of state level of lack of health insurance among women of reproductive age with variation in state LBW rates.

Study Design: This study analyzes data from the 2016-2019 Pregnancy Risk Assessment Monitoring System(PRAMS) survey for respondents with singleton, live births. Respondents were divided into quartiles by state-level percent of uninsured women aged 19-44. P</span>oisson regression models estimated the likelihood of LBW, testing the significance of state-level lack of health insurance after controlling for individual sociodemographic and clinical risk factors. Sensitivity analyses included testing the significance of state Gini coefficients (a ranking of income inequality), total and public welfare expenditures, and state reproductive rights rankings.

Results: In this weighted analysis of 7, 127,412 respondents, 6.22% experienced LBW. State-level linear correlations showed a modest but statistically significant association between uninsured and LBW. In adjusted multiple regression analyses, compared to states with < 7% uninsured, respondents from states with 7% or more uninsured had approximately a 10% higher likelihood of LBW (Table). However, there was no evident dose-response gradient. Findings were virtually identical for PRAMS sensitivity analyses.

Conclusion: States with the highest level of insurance coverage had a significantly lower LBW rate than other states. However, there was little evidence for greater odds of LBW with the highest levels of uninsured. Individual risk factors dominated LBW models while state differences in insurance coverage, income inequality, reproductive health policy, and per capita spending explained little of the variance in LBW.

Primary & Presenting Author(s)

MP
Madeline F. Perry, MD
Northwestern University
Chicago, Illinois, United States

Coauthor(s)

ET
Emma Trasatti, MPH
Northwestern University
Chicago, Illinois, United States
Lynn M. Yee, MD,MPH (she/her/hers)
Associate Professor
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
JF
Joe M. Feinglass, PhD
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States