163 Private or Public Health Insurance and Infant Outcomes in the United States
OBJECTIVES/GOALS: Health insurance status is associated with differences in access to healthcare and health outcomes. The objective of this study was to test the hypothesis that among infants born in the United States, maternal private insurance compared with public Medicaid insurance would be assoc...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2022-04-01
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| Series: | Journal of Clinical and Translational Science |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2059866122000711/type/journal_article |
| _version_ | 1811155286352723968 |
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| author | Desalyn Louise Johnson Waldemar Carlo Fazlur AKM Rahman Rachel Tindal Colm Travers |
| author_facet | Desalyn Louise Johnson Waldemar Carlo Fazlur AKM Rahman Rachel Tindal Colm Travers |
| author_sort | Desalyn Louise Johnson |
| collection | DOAJ |
| description | OBJECTIVES/GOALS: Health insurance status is associated with differences in access to healthcare and health outcomes. The objective of this study was to test the hypothesis that among infants born in the United States, maternal private insurance compared with public Medicaid insurance would be associated with a lower infant mortality rate (IMR). METHODS/STUDY POPULATION: This ecological study used data from the Center for Disease Control and Prevention (CDC) WONDER expanded linked birth and infant death records database 2017-2018. We included hospital-born infants from 20 to 42 weeks of gestational age (wga) if the mother had either private or Medicaid insurance. We excluded infants with congenital anomalies and infants who died due to congenital anomalies. We used negative-binomial regression adjusted for race, sex, multiple birth, and any maternal pregnancy risk factors (as defined by the CDC) to determine the difference in IMR between private and Medicaid insurance. Chi-square or Fishers exact test was used to compare differences in categorical variables between groups. RESULTS/ANTICIPATED RESULTS: We included 6,901,328 infants; 53.6% had private insurance and 46.4% were insured by Medicaid. Privately insured infants had a lower IMR compared with Medicaid insured infants (2.84/1000 vs. 5.32/1000; adjusted relative risk (aRR) 0.71; 95% confidence intervals (CI) 0.62 to 0.81; p<.0001). The privately insured had higher rates of 1st trimester prenatal care compared to those with Medicaid (85.6% vs. 66.6%; p<.00001). Rates of infant morbidity and maternal morbidity (per CDC definitions) were lower among the privately insured compared to those with Medicaid (both p<.00001). The privately insured had lower rates of preterm (9.1% vs. 11.0%), extremely preterm (0.5% vs. 0.7%), low birth weight (7.1% vs. 9.6%), and extremely low birth weight (0.5% vs. 0.7%) births compared to those with Medicaid (all p<0.001). DISCUSSION/SIGNIFICANCE: Private insurance is associated with a lower IMR compared to Medicaid insurance. Privately insured pregnancies also have higher rates of early prenatal care, less morbidity, and less preterm and low birth weight births. There may be opportunities to improve access to care and pregnancy outcomes among Medicaid insured pregnancies in the United States. |
| first_indexed | 2024-04-10T04:31:49Z |
| format | Article |
| id | doaj.art-6c83b73e521540088220ec328eb97854 |
| institution | Directory Open Access Journal |
| issn | 2059-8661 |
| language | English |
| last_indexed | 2024-04-10T04:31:49Z |
| publishDate | 2022-04-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Journal of Clinical and Translational Science |
| spelling | doaj.art-6c83b73e521540088220ec328eb978542023-03-10T07:53:47ZengCambridge University PressJournal of Clinical and Translational Science2059-86612022-04-016181810.1017/cts.2022.71163 Private or Public Health Insurance and Infant Outcomes in the United StatesDesalyn Louise Johnson0Waldemar Carlo1Fazlur AKM Rahman2Rachel Tindal3Colm Travers4Center for Clinical and Translational Science (CCTS)Neonatology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United StatesBiostatistics, The University of Alabama at Birmingham School of Public Health, Birmingham, AL, United StatesThe University of Alabama at Birmingham School of Medicine, Birmingham, AL, United StatesNeonatology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United StatesOBJECTIVES/GOALS: Health insurance status is associated with differences in access to healthcare and health outcomes. The objective of this study was to test the hypothesis that among infants born in the United States, maternal private insurance compared with public Medicaid insurance would be associated with a lower infant mortality rate (IMR). METHODS/STUDY POPULATION: This ecological study used data from the Center for Disease Control and Prevention (CDC) WONDER expanded linked birth and infant death records database 2017-2018. We included hospital-born infants from 20 to 42 weeks of gestational age (wga) if the mother had either private or Medicaid insurance. We excluded infants with congenital anomalies and infants who died due to congenital anomalies. We used negative-binomial regression adjusted for race, sex, multiple birth, and any maternal pregnancy risk factors (as defined by the CDC) to determine the difference in IMR between private and Medicaid insurance. Chi-square or Fishers exact test was used to compare differences in categorical variables between groups. RESULTS/ANTICIPATED RESULTS: We included 6,901,328 infants; 53.6% had private insurance and 46.4% were insured by Medicaid. Privately insured infants had a lower IMR compared with Medicaid insured infants (2.84/1000 vs. 5.32/1000; adjusted relative risk (aRR) 0.71; 95% confidence intervals (CI) 0.62 to 0.81; p<.0001). The privately insured had higher rates of 1st trimester prenatal care compared to those with Medicaid (85.6% vs. 66.6%; p<.00001). Rates of infant morbidity and maternal morbidity (per CDC definitions) were lower among the privately insured compared to those with Medicaid (both p<.00001). The privately insured had lower rates of preterm (9.1% vs. 11.0%), extremely preterm (0.5% vs. 0.7%), low birth weight (7.1% vs. 9.6%), and extremely low birth weight (0.5% vs. 0.7%) births compared to those with Medicaid (all p<0.001). DISCUSSION/SIGNIFICANCE: Private insurance is associated with a lower IMR compared to Medicaid insurance. Privately insured pregnancies also have higher rates of early prenatal care, less morbidity, and less preterm and low birth weight births. There may be opportunities to improve access to care and pregnancy outcomes among Medicaid insured pregnancies in the United States.https://www.cambridge.org/core/product/identifier/S2059866122000711/type/journal_article |
| spellingShingle | Desalyn Louise Johnson Waldemar Carlo Fazlur AKM Rahman Rachel Tindal Colm Travers 163 Private or Public Health Insurance and Infant Outcomes in the United States Journal of Clinical and Translational Science |
| title | 163 Private or Public Health Insurance and Infant Outcomes in the United States |
| title_full | 163 Private or Public Health Insurance and Infant Outcomes in the United States |
| title_fullStr | 163 Private or Public Health Insurance and Infant Outcomes in the United States |
| title_full_unstemmed | 163 Private or Public Health Insurance and Infant Outcomes in the United States |
| title_short | 163 Private or Public Health Insurance and Infant Outcomes in the United States |
| title_sort | 163 private or public health insurance and infant outcomes in the united states |
| url | https://www.cambridge.org/core/product/identifier/S2059866122000711/type/journal_article |
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