Does Universal Coverage Mitigate Racial Disparities in Potentially Avoidable Maternal Complications?

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

Authors' Contributions

A.R., T.A., C.M., T.K., C.W., B.S., S.E.L., and J.R. made substantial contributions to the conception or design of the work. A.R. and T.K. participated in the acquisition of the data. A.R. and T.A. were responsible for data analysis. A.R., T.A., and C.M. drafted the manuscript, and T.A., B.S., T.K., C.W., S.E.L., and J.R. critically revised the manuscript for intellectual content. All authors provided final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Note

The content of this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the Uniformed Services University of the Health Sciences, the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense, or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the US government. The Center for Surgery and Public Health and the Uniformed Services University of Health Sciences are funded by the Defense Health Agency, Award (#HU0001-11-1-0023) to provide salary support for protected research efforts involving analysis and study of military TRICARE data. The following investigators receive corresponding partial salary support: T.A.

Publication History

Received: 05 September 2019

Accepted: 16 December 2019

Article published online:
27 January 2020

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