Racial and ethnic disparities in potentially avoidable delivery complications among pregnant Medicaid beneficiaries in South Carolina.
OBJECTIVE
To examine race and ethnicity differences in accessibility and effectiveness of health care during pregnancy.


METHODS
Data were 26,866 year 2000 Medicaid-insured deliveries from the South Carolina Office of Research and Statistics, and Area Resource File. The access indicator was Potentially Avoidable Maternity Complications (PAMCs). PAMC risks can be reduced through prenatal care, such as infection screening and treatment, and healthy behaviors it promotes. We compared PAMC risks of Blacks, Hispanics, and Whites. Analyses included PAMC rates, Chi-square, t-tests, multilevel logistic regression. Risks were estimated for ages 10-17, and 18+.


RESULTS
At ages 10-17 (n=2,691), Blacks and Hispanics had notably higher unadjusted and adjusted PAMC risks (adjusted odds ratios, ORs, 2.26, p < .001; 3.29, p < .05, respectively). At ages 18+, adjusted odds for Hispanics were about half those of Whites (p < .05). Adjusted odds for adult Blacks and Whites did not differ. This may be due to controlling for many risk factors that are more prevalent among Blacks: Single, disabled, poverty, diabetes, hypertension, rurality; however, unadjusted PAMC prevalence also did not differ greatly (3.9 for Blacks, 3.4 for Whites, p < .1). Adjusted risks were high for adults with diabetes (OR 2.40, p < .001) and all rural women (teen OR 4.02, p < .05; adult OR 1.83, p < .001).


CONCLUSIONS
Young Blacks and Hispanics have notably higher risks of delivery outcomes indicating less access to prenatal care of reasonable quality. Policies to reduce PAMCs in Medicaid should address needs of young Blacks and Hispanics; enhance diabetes treatment for adult women; and address rural access barriers for all women.
Laditka
Sarah B
SB
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, 29208, USA. sladitka@gwm.sc.edu
Laditka
James N
JN
Probst
Janice C
JC
D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data*; D002648:Child; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid / Q000592:standards / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology*; D011256:Pregnancy Outcome / Q000208:ethnology*; D011253:Pregnancy in Adolescence / Q000208:ethnology / Q000706:statistics & numerical data; D015995:Prevalence; D011787:Quality of Health Care; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013022:South Carolina / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American