State-Level Prevalence of Maternity Care Deserts: Association With Healthcare Access, Utilization, and Outcomes Among Medicaid Recipients

Dara E. Gleeson MPH, CHES , Susan H. Busch PhD , Jeannette R. Ickovics PhD
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引用次数: 0

Abstract

Introduction

More than 2 million women of childbearing age live in U.S. counties without access to maternity care—counties referred to as maternity care deserts. The objective of this study was to identify whether living in a state with a high prevalence of maternity care deserts is associated with maternal and child health access and utilization and contributing to adverse health outcomes among Medicaid recipients.

Methods

This is a descriptive, cross-sectional, secondary data analysis using most recent data available (2021–2023) from multiple existing state-level sources (e.g., Medicaid Health Care Core Data Sets, March of Dimes Peristats, Pregnancy Risk Assessment Monitoring System). State-level analyses included all U.S. states, District of Columbia, and Puerto Rico (N=52). Analyses were stratified by state prevalence of maternity care deserts (high=states where ≥21% of counties have no hospital/birth center providing obstetric services). Multivariate analyses of covariance were used to test associations with 3 domains of dependent variables: healthcare access (i.e., mental health, pediatrics, family medicine), utilization (e.g., timely access to pre and postnatal care, vaccinations), and maternal/child health outcomes (e.g., maternal and infant mortality).

Results

Three multivariate analysis of covariance tests indicated significant main effects for state-level maternity care desert prevalence and all domains (all p<0.009), with large effect sizes (η2≥0.14). Effects were durable, even after controlling for state-level covariates. States/territories with high prevalence of maternity care deserts had more rural counties (t= −4.22, p<0.001), lower levels of educational attainment (t= −2.32, p=0.024), and lower median household income (t=3.09, p=0.004). Those living in states/territories with high prevalence of maternity care deserts had 30% fewer mental healthcare providers (487.50 vs 696.50/100,000 population) and 36% fewer pediatricians (14.25 vs 22.31/100,000 population). They were ∼14% less likely to receive timely prenatal and postpartum care. Infants were 28.62% less likely to receive influenza vaccinations before second birthday. Critically, those in states/territories with high prevalence of maternity care deserts had 34.20% greater risk of maternal mortality, 18.34% greater risk of infant mortality, and 8.92% greater risk of low birthweight.

Conclusions

High state-level prevalence of maternity care deserts is associated with adverse maternal and child outcomes; exacerbating concerns as health during the perinatal period sets the trajectory for health across the lifespan. Policy and practice solutions must address pervasive health inequities associated with maternity care deserts (e.g., expanding access to maternity care through family medicine physicians, doulas, telehealth access, and supporting rural obstetric readiness).
州一级产妇护理沙漠的流行:与医疗保健获取、利用和医疗补助接受者的结果的关联
超过200万育龄妇女生活在美国无法获得产科护理的县,这些县被称为产科护理沙漠。本研究的目的是确定生活在一个产妇保健沙漠高发的州是否与妇幼保健的获取和利用有关,并导致医疗补助接受者的不良健康结果。方法:这是一项描述性、横断面、二手数据分析,使用来自多个现有国家级来源的最新数据(2021-2023年)(例如,医疗补助医疗核心数据集、March of Dimes Peristats、妊娠风险评估监测系统)。州级分析包括美国所有州、哥伦比亚特区和波多黎各(N=52)。分析按州产妇护理沙漠的流行程度进行分层(高=≥21%的县没有医院/生育中心提供产科服务的州)。使用多变量协方差分析来检验与3个因变量域的关联:医疗保健获取(即心理健康、儿科、家庭医学)、利用(例如及时获得产前和产后护理、接种疫苗)和孕产妇/儿童健康结果(例如孕产妇和婴儿死亡率)。结果3个多变量协方差检验均显示,国家级产妇护理沙漠患病率和各领域主效应显著(均p<;0.009),且效应量较大(η2≥0.14)。即使在控制了州一级的协变量之后,效果也是持久的。产妇保健沙漠高流行的州/地区有更多的农村县(t= - 4.22, p= 0.001),受教育程度较低(t= - 2.32, p=0.024),家庭收入中位数较低(t=3.09, p=0.004)。生活在产妇保健沙漠高流行的州/地区的人,精神保健提供者少30%(487.50人对696.50人/10万人),儿科医生少36%(14.25人对22.31人/10万人)。他们接受及时产前和产后护理的可能性低约14%。婴儿在两岁前接种流感疫苗的可能性要低28.62%。至关重要的是,在产妇保健沙漠高流行的州/地区,产妇死亡率风险高出34.20%,婴儿死亡率风险高出18.34%,低出生体重风险高出8.92%。结论高水平的国家级孕产妇保健沙漠患病率与不良母婴结局相关;围产期健康问题的加剧决定了整个生命周期的健康轨迹。政策和实践解决办法必须解决与产妇护理沙漠相关的普遍卫生不公平现象(例如,通过家庭医生、助产师、远程保健服务扩大获得产妇护理的机会,并支持农村产科准备)。
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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AJPM focus
AJPM focus Health, Public Health and Health Policy
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