Abstract
Objective Potentially avoidable maternity complications (PAMCs) have been validated as an indicator
of access to quality prenatal care. African-American mothers have exhibited a higher
incidence of PAMCs, which has been attributed to unequal health coverage. The objective
of this study was to assess if racial disparities in the incidence of PAMCs exist
in a universally insured population.
Study Design PAMCs in each racial group were compared relative to White mothers using multivariate
logistic regression. Stratified subanalyses assessed for adjusted differences in the
odds of PAMCs for each racial group within direct versus purchased care.
Results A total of 675,553 deliveries were included. Among them, 428,320 (63%) mothers were
White, 112,170 (17%) African-American, 37,151 (6%) Asian/Pacific Islanders, and 97,912
(15%) others. African-American women (adjusted odds ratio [aOR]: 1.05, 95% CI: 1.02–1.08)
were more likely to have PAMCs compared with White women, and Asian women (aOR: 0.92,
95% CI: 0.89–0.95) were significantly less likely to have PAMCs compared with White
women. On stratified analysis according to the system of care, equal odds of PAMCs
among African-American women compared with White women were realized within direct
care (aOR: 1.03, 95% CI: 1.00–1.07), whereas slightly higher odds among African-American
persisted in purchased (aOR: 1.05, 95% CI: 1.01–1.10).
Conclusion Higher occurrence of PAMCs among minority women sponsored by a universal health coverage
was mitigated compared with White women. Protocol-based care as in the direct care
system may help overcome health disparities.
Keywords
universal health coverage - potentially avoidable maternal complications - racial
disparities - TRICARE - claims data
