title: Ectopic pregnancy morbidity and mortality in low-income women, 2004-2008.
abstract: OBJECTIVE
  Does the risk of adverse outcomes at the time of ectopic pregnancy vary by race/ethnicity among women receiving Medicaid, the public health insurance program for low-income people in the USA?
  
  
  CONCLUSIONS
  Among Medicaid beneficiaries with ectopic pregnancy, 11% experienced at least one complication, and women from all racial/ethnic minority groups were significantly more likely than whites to experience complications.
  
  
  BACKGROUND
  In this population of Medicaid recipients, African American women are significantly more likely than whites to experience ectopic pregnancy, but the risk of adverse outcomes has not previously been assessed.
  
  
  METHODS
  We conducted a cross-sectional observational study of all women (n = 19 135 106) ages 15-44 enrolled in Medicaid for any amount of time during 2004-2008 who lived in one of the following 14 US states: Arizona; California; Colorado; Florida; Illinois; Indiana; Iowa; Louisiana; Massachusetts; Michigan; Minnesota; Mississippi; New York; and Texas.
  
  
  METHODS
  We analyzed Medicaid claims records for inpatient and outpatient encounters and identified ectopic pregnancies with a principal diagnosis code for ectopic pregnancy from 2004-2008. We calculated the ectopic pregnancy complication rate as the number of ectopic pregnancies with at least one complication (blood transfusion, hysterectomy, any sterilization, or length-of-stay (LOS) > 2 days) divided by the total number of ectopic pregnancies. We used Poisson regression to assess the risk of ectopic pregnancy complication by race/ethnicity. Secondary outcomes were each individual complication, and ectopic pregnancy-related death. We calculated the ectopic pregnancy mortality ratio as the number of deaths divided by live births.
  
  
  RESULTS
  Ectopic pregnancy-associated complications occurred in 11% of cases. Controlling for age and state, the risk of any complication was significantly higher among women who were black (incidence risk ratio [IRR] 1.47, 95% CI 1.43-1.53, P < 0.0001), Hispanic (IRR 1.16, 95% CI 1.12-1.21, P < 0.0001), Asian (IRR 1.34, 95% CI 1.24-1.45, P < 0.0001), American Indian/Alaskan Native (IRR 1.34 95% CI 1.16-1.55, P < 0.0001), and Native Hawaiian/Pacific Islander (IRR 1.61, 95% CI 1.39-1.87, P < 0.0001) compared with white women. The ectopic pregnancy mortality ratio was 0.48 per 100 000 live births, similar to that reported in previous US surveillance.
  
  
  CONCLUSIONS
  This is a secondary analysis of insurance claims.
  
  
  CONCLUSIONS
  Among women at higher baseline risk of pregnancy complications due to their economic status, women from racial/ethnic minority groups face an additional risk of ectopic pregnancy adverse outcomes compared with whites. Systematic changes to reduce racial disparities are an essential part of improving maternal health in the USA.
  
  
  BACKGROUND
  The Eunice Kennedy Shriver National Institute of Child Health and Human Development (1 K08 HD060663 to D.B.S.). The authors report no conflict of interest.
  
  
  BACKGROUND
  Not applicable.
authors.affiliation: Department of Family Medicine, University of Chicago, 5841 S. Maryland Ave., MC 7110, Suite M-156, Chicago, IL 60637, USA Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA stulberg@uchicago.edu.
authors.forename: D B
authors.initials: DB
authors.lastname: Stulberg
authors.affiliation: Department of Family Medicine, University of Chicago, 5841 S. Maryland Ave., MC 7110, Suite M-156, Chicago, IL 60637, USA.
authors.forename: L
authors.initials: L
authors.lastname: Cain
authors.affiliation: Department of Family Medicine, University of Chicago, 5841 S. Maryland Ave., MC 7110, Suite M-156, Chicago, IL 60637, USA.
authors.forename: I H
authors.initials: IH
authors.lastname: Dahlquist
authors.affiliation: Department of Public Health Sciences, University of Chicago, 5841 S. Maryland Ave. MC 2000, Chicago, IL 60637, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Lauderdale
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D007902:Length of Stay; D008484:Medicaid; D009017:Morbidity; D016012:Poisson Distribution; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000453:epidemiology*; D012959:Socioeconomic Factors; D014481:United States
keywords: African Americans; Asian Americans; Hispanic Americans; Medicaid; Native Americans; Pacific Island Americans; ectopic pregnancy; female sterilization; healthcare disparities; pregnancy complication