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Oral Concurrent Session 4 - Health Equity and Policy
Oral Concurrent Sessions
Expedited Sessions
To determine whether neighborhood socioeconomic disadvantage is associated with an increased risk of postpartum readmission.
Study Design:
A secondary analysis from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be, a prospective cohort of nulliparous pregnant individuals. Participant home addresses were geocoded at the census tract level and linked to the 2015 Area Deprivation Index (ADI). The ADI combines metrics from the domains of income, education, employment, and housing quality into a composite score that is converted to a rank based on a locale’s national percentile. The ADI was analyzed in quartiles from the lowest ADI (quartile 1 [Q1], reference) to the highest ADI (Q4). The outcome was hospital readmission within 14 days of delivery discharge for any indication. Poisson regression with robust error variance was used. The adjusted model incorporated individual-level covariates previously associated with postpartum readmission, including socio-demographic (age, Medicaid status, self-reported race and ethnicity as a social determinant of health), clinical (chronic hypertension, diabetes in pregnancy), and obstetric characteristics (gestational age at delivery).
Results: Of 9,466 individuals with follow-up data, 1.8% (n=166) were readmitted postpartum within two weeks of delivery discharge. The primary indications (not mutually exclusive) for postpartum readmission were infection (33.7%), preeclampsia (23.5%), and bleeding (6.6%). The frequency of readmission increased with neighborhood deprivation, from the lowest (least disadvantaged) to highest (most disadvantaged) ADI quartile: (Q1: 1.2%; Q2: 1.6%; Q3: 1.7%; and Q4: 2.3%; overall p-value=0.05). In multivariable analysis, individuals living in ADI Q4 were significantly more likely to be readmitted postpartum compared to those living in ADIQ1 (adjusted risk ratio, aRR: 1.75; 95% CI: 1.06 to 2.89).
Conclusion:
Residence within the most disadvantaged U.S. neighborhoods was associated with increased risk of postpartum readmission among nulliparous pregnant individuals.
Jenna C. Meiman, MD, MPH (she/her/hers)
The Ohio State University
Columbus, Ohio, United States
William A. Grobman, MD, MBA
Vice Chair, Clinical Operations, Maternal Fetal Medicine
The Ohio State University
Columbus, Ohio, United States
Lynn M. Yee, MD,MPH (she/her/hers)
Associate Professor
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
David M. Haas, MD, MSCR
Attending Physician
Indiana University Health
Carmel, Indiana, United States
Rebecca B. McNeil, PhD
RTI International
Research Triangle, North Carolina, United States
Judith H. Chung, MD, PhD
Professor of Clinical Obstetrics and Gynecology
UC Irvine Health
Orange, California, United States
Brian M. Mercer, MD
Department Chair of Obstetrics & Gynecology
Case Western Reserve University and The MetroHealth System
Cleveland, Ohio, United States
Hyagriv Simhan, MD
Professor
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
Uma M. Reddy, MD,MPH
Professor and Vice Chair of Research, Department of Obstetrics and Gynecology
Columbia University
New York, New York, United States
Robert M. Silver, MD
University of Utah Health
Salt Lake City, Utah, United States
Samuel Parry, MD
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
Ronald J. Wapner, MD
Professor of OBGYN; Vice Chair of Research; Director of Reproductive Genetics
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center
New York, NY, United States
George R. Saade, MD
Professor & Chief of Obstetrics & Maternal-Fetal Medicine
University of Texas Medical Branch
Galveston, Texas, United States
Courtney Denning-Johnson Lynch, MPH, PhD
Associate Professor, Obstetrics & Gynecology and Epidemiology
The Ohio State University
Columbus, Ohio, United States
Kartik Kailas Venkatesh, MD, PhD (he/him/his)
Assistant Professor
The Ohio State University
Columbus, Ohio, United States