Reduced odds of severe maternal morbidity associated with the US Affordable Care Act dependent coverage provision

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm Pub Date : 2025-03-11 DOI:10.1016/j.ajogmf.2025.101668

Jean Guglielminotti MD, PhD , Jamie R. Daw PhD , Alexander M. Friedman MD, MPH , Goleen Samari PhD , Guohua Li MD, DrPH

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引用次数: 0

Abstract

Background

Continuous perinatal health insurance coverage is a policy intervention that may help reduce severe maternal morbidity (SMM) and racial and ethnic disparities in SMM in the United States. The Affordable Care Act Dependent Coverage Provision (DCP) allowed young adults to remain on their parent's private health insurance plan until their 26^th birthday but its effectiveness in reducing SMM has not been evaluated.

Objective

To assess the association of the DCP with SMM during delivery hospitalization.

Study design

Difference-in-differences analysis of US delivery hospitalizations from January 2006 to September 2015, stratified according to maternal race and ethnicity. The outcome was SMM exclusive of blood transfusion only, as defined by the Centers for Disease Control and Prevention criteria. The exposure was maternal age categorized into 21 to 25 years (covered by the DCP) and 27 to 31 years (not covered the DCP). The intervention was the DCP categorized into pre- and post-DCP periods (January 2006-September 2010 and October 2010-September 2015, respectively).

Results

Of the 4,007,937 delivery hospitalizations in the sample, 22,540 (56.2 per 10,000) recorded SMM. For birthing people aged 21 to 25 years (covered by the DCP), the mean SMM rate was 48.9 per 10,000 during the pre-DCP period and 58.2 per 10,000 during the post-DCP period (crude difference: 9.3 per 10,000). For birthing people aged 27 to 31 years (not covered the DCP), the mean SMM rate was 53.4 per 10,000 during the pre-DCP period and 63.6 per 10,000 during the post-DCP period (crude difference: 10.2 per 10,000). Implementation of DCP was associated with a 1.2% (95% CI: −3.6, 1.3) relative decrease in the mean SMM rate (adjusted odds ratio (aOR): 0.988; 95% CI: 0.964, 1.013). For non-Hispanic White people, the DCP was associated with a 10.7% (95% CI: 7.1, 14.2) relative decrease in the mean SMM rate (aOR: 0.893; 95% CI: 0.858, 0.929). The DCP was associated with an increase in the proportion of privately insured (aOR: 1.225; 95% CI: 1.220, 1.231), a decrease in the proportion of Medicaid beneficiaries (aOR: 0.853; 95% CI: 0.849, 0.856), and a decrease in the proportion of uninsured (aOR: 0.807; 95% CI: 0.798, 0.816).

Conclusions

Maternal health benefit of the DCP appears to be limited to non-Hispanic White birthing people.

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降低与美国平价医疗法案相关的严重孕产妇发病率的几率。

背景：持续的围产期健康保险覆盖范围是一项政策干预，可能有助于减少严重产妇发病率（SMM）和种族和民族差异的SMM在美国。《负担得起的医疗法案》家属保险条款（DCP）允许年轻人在26岁生日之前继续使用父母的私人健康保险计划，但其在减少SMM方面的有效性尚未得到评估。目的：探讨分娩住院期间DCP与SMM的关系。研究设计：对2006年1月至2015年9月美国分娩住院的差异中差异分析，按产妇种族和民族分层。根据疾病控制和预防中心的标准，结果是SMM不包括输血。暴露的母亲年龄分为21至25岁（包括DCP）和27至31岁（未包括DCP）。干预是分为前后两期的DCP（分别为2006年1月至2010年9月和2010年10月至2015年9月）。结果：在样本中的4,007,937例分娩住院中，22,540例（56.2 / 10,000）记录了SMM。对于21-25岁的生育人群（包括在计划生育范围内），计划生育前的平均SMM率为48.9 / 10,000，计划生育后的平均SMM率为58.2 / 10,000（粗差：9.3 / 10,000）。对于27-31岁的待产人群（不包括DCP），在DCP前的平均SMM率为53.4 / 10,000，在DCP后的平均SMM率为63.6 / 10,000（粗差：10.2 / 10,000）。实施DCP与平均SMM率相对下降1.2% （95% CI: -3.6, 1.3）相关(调整优势比（aOR）： 0.988；95% ci: 0.964, 1.013)。对于非西班牙裔白人，DCP与平均SMM率相对下降10.7% （95% CI: 7.1, 14.2）相关(aOR: 0.893；95% ci: 0.858, 0.929)。DCP与私人保险比例的增加有关(aOR: 1.225；95% CI: 1.220, 1.231)，医疗补助受益人比例下降(aOR: 0.853；95% CI: 0.849, 0.856)，未参保比例下降(aOR: 0.807；95% ci: 0.798, 0.816)。结论：DCP对产妇健康的益处似乎仅限于非西班牙裔白人产妇。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Obstetrics & Gynecology Mfm Medicine-Medicine (all)

CiteScore

7.40

自引率

3.20%

发文量

254

审稿时长

40 days

期刊介绍： The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including: Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women. Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health. Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child. Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby. Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.