Delivery complications associated with prenatal care access for Medicaid-insured mothers in rural and urban hospitals.
BACKGROUND
Pregnancy complications affect many women. It is likely that some complications can be avoided through routine primary and prenatal care of reasonable quality.


OBJECTIVE
The authors examined access to health care during pregnancy for mothers insured by Medicaid. The access indicator is potentially avoidable maternity complications (PAMCs). Potentially avoidable maternity complications are often preventable through routine prenatal care, such as infection screening and treatment. The authors examined the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity.


METHODS
Data are from the year 2000 Nationwide Inpatient Sample (NIS). The stratified sample represents all discharges from 20.5% of community hospitals in the United States. The Nationwide Inpatient Sample identifies hospital locations, but not patients' areas of residence. Analyses, which accounted for the sample design, included calculation of potentially avoidable maternity complication rates by race or ethnicity, chi2, t tests, and multivariate logistic regression.


RESULTS
Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals (odds ratio, 0.78; CI, 0.62 to 0.99). In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites (odds ratio, 1.72; CI, 1.26 to 2.36). In urban hospitals, risk of potentially avoidable maternity complications was not significantly higher for African Americans. Hispanics and Asians had notably lower risks of potentially avoidable maternity complications in urban hospitals than did non-Hispanic whites.


CONCLUSIONS
Providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.
Laditka
Sarah B
SB
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA. sladitka@gwm.sc.edu
Laditka
James N
JN
Bennett
Kevin J
KJ
Probst
Janice C
JC
D000293:Adolescent; D000328:Adult; D002391:Catchment Area, Health; D002648:Child; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006306:Health Surveys; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000208:ethnology*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology