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Obstet Gynecol. 2015 Nov;126(5):1040-7. doi: 10.1097/AOG.0000000000001090.

Racial and Ethnic Disparities in Hospital Readmissions After Delivery.

Author information

1
Division of Behavioral Sciences and Community Health and Center for Public Health and Health Policy and the Department of Obstetrics and Gynecology, UConn Health, Farmington, the Department of Statistics and Center for Public Health and Health Policy, University of Connecticut, Storrs, the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, and the Department of Obstetrics and Gynecology, Yale New Haven Hospital, New Haven, and the Connecticut State Medical Society, North Haven, Connecticut.

Abstract

OBJECTIVE:

To examine 30-day readmission rates after vaginal and cesarean delivery by race-ethnicity and insurance status.

METHODS:

We analyzed hospital discharge data contained in a statewide database maintained by the Connecticut Department of Public Health. Discharge data for patients admitted for vaginal delivery without complication (n=167,857) and cesarean delivery without complication (n=75,552) from 2005 to 2012 were analyzed using marginal logistic models for clustered data with generalized estimating equations.

RESULTS:

Results from logistic models indicated that 30-day readmission rates per 1,000 patients were significantly higher among black (28.9/1,000; confidence interval [CI] 25.5-32.7) and Hispanic women (21.4/1,000; CI 18.9-24.2) than among white women (12.9/1,000; CI 11.9-14.0) after cesarean delivery. Similarly higher rates of readmission were observed for black (14.6/1,000; CI 13.0-16.5) and Hispanic women (10.7/1,000; CI 9.6-12.0) relative to white women (7.5/1,000; CI 7.0-8.1) after vaginal delivery. Rates of 30-day readmission were significantly higher (odds ratio 1.27-1.30) among those covered by Medicaid. Controlling for patient socioeconomic status, comorbidities, and payer did not substantially reduce race and ethic differences in the odds of readmission.

CONCLUSION:

Significant racial and ethnic disparities in readmissions were observed for procedures related to childbirth using a statewide database capturing all payers across all acute care hospital settings. Compared with white women, black women were twice as likely and Hispanic women 40-50% more likely to be readmitted within 30 days of vaginal or cesarean delivery.

LEVEL OF EVIDENCE:

II.

Comment in

PMID:
26444126
DOI:
10.1097/AOG.0000000000001090
[Indexed for MEDLINE]

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