Socioeconomic disparities in ectopic pregnancy: predictors of adverse outcomes from Illinois hospital-based care, 2000-2006.
This study aimed to identify the incidence of adverse outcomes from ectopic pregnancy hospital care in Illinois (2000-2006), and assess patient, neighborhood, hospital and time factors associated with these outcomes. Discharge data from Illinois hospitals were retrospectively analyzed and ectopic pregnancies were identified using DRG and ICD-9 diagnosis codes. The primary outcome was any complication identified by ICD-9 procedure codes. Secondary outcomes were length of stay and discharge status. Residential zip codes were linked to 2000 U.S. Census data to identify patients' neighborhood demographics. Logistic regression was used to identify risk factors for adverse outcomes. Independent variables were insurance status, age, co-morbidities, neighborhood demographics, hospital type, hospital ectopic pregnancy service volume, and year of discharge. Of 13,007 ectopic pregnancy hospitalizations, 7.4% involved at least one complication identified by procedure codes. Hospitalizations covered by Medicare (for women with chronic disabilities) were more likely than those with other source or without insurance to result in surgical sterilization (OR 4.7, P = 0.012). Hospitalization longer than 2 days was more likely with Medicaid (OR 1.46, P < 0.0005) or no insurance (OR 1.35, P < 0.0005) versus other payers, and among church-operated versus secular hospitals (OR 1.21, P < 0.0005). Compared to public hospitals, private hospitals had lower rates of complications (OR 0.39, P < 0.0005) and of hospitalization longer than 2 days (OR 0.57, P < 0.0005). With time, hospitalizations became shorter (OR 0.53, P < 0.0005) and complication rates higher (OR 1.33, P = 0.024). Ectopic pregnancy patients with Medicaid, Medicare or no insurance, and those admitted to public or religious hospitals, were more likely to experience adverse outcomes.
Stulberg
Debra B
DB
Department of Family Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA. stulberg@uchicago.edu
Zhang
James X
JX
Lindau
Stacy Tessler
ST
D000293:Adolescent; D000328:Adult; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006779:Hospitals, Public; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D019458:Insurance Coverage; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D013513:Obstetric Surgical Procedures / Q000145:classification; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult