Changes in the utilization of prenatal and delivery services in the United States prior to, during, and after the COVID-19 pandemic.

IF 3.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Hannah Silverstein, Larissa Jennings Mayo-Wilson, Anna Austin
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引用次数: 0

Abstract

Background: Starting in March 2020, the COVID-19 pandemic strained the healthcare system in the United States, directly and indirectly changing the provision of many types of care, including maternity care. This paper describes longer-term changes in maternal health services utilization in the U.S. during the COVID-19 pandemic.

Methods: Using United States monthly aggregated birth record data from 2016 to 2023, we examined changes in the average number of prenatal visits (overall and by delivery pay type) and total births (overall, by pay type, and by birthplace) before, during, and after the pandemic. We estimated monthly time series models replicating pre-pandemic patterns from January 2016 to February 2020. We then extended those models to predict monthly levels of each outcome had COVID-19 not occurred from March 2020 through December 2023. We compared observed and predicted levels from March 2020 onward, assessing differences associated with COVID-19.

Results: There were persistent and significantly lower-than-expected levels of average number of prenatal care visit across all COVID-19 months. There was also a temporary significant drop in total births during 2020 that recovered to expected levels in 2021, except for an increase in the total self-pay births in 2023. Patterns by pay type were similar to the overall patterns observed. Total non-hospital births were significantly higher than expected for the entirety of the pandemic, with large increases in intentional home births.

Conclusion: Most initial changes to maternity care persisted throughout and continued after the pandemic, resulting in lower levels of prenatal care visits and higher numbers of home births. These findings show sustained changes to maternity care provision and access prompted by COVID-19, which highlight how vulnerable maternity services are to healthcare disruptions and suggest prolonged effects on equitable access to safe care.

在COVID-19大流行之前、期间和之后,美国产前和分娩服务利用的变化。
背景:从2020年3月开始,COVID-19大流行使美国的医疗保健系统紧张,直接和间接地改变了许多类型的医疗服务的提供,包括产科护理。本文描述了COVID-19大流行期间美国孕产妇保健服务利用的长期变化。方法:利用2016年至2023年美国每月汇总出生记录数据,研究了大流行之前、期间和之后平均产前就诊次数(总体和按分娩工资类型划分)和总出生次数(总体、按工资类型和按出生地划分)的变化。我们估计了从2016年1月到2020年2月复制大流行前模式的每月时间序列模型。然后,我们扩展了这些模型,以预测从2020年3月到2023年12月没有发生COVID-19的每个月的结果水平。我们比较了2020年3月以来的观测和预测水平,评估了与COVID-19相关的差异。结果:在COVID-19的所有月份中,平均产前护理就诊次数持续且显著低于预期。除了2023年自费出生总数增加外,2020年出生总数也出现了短暂的大幅下降,到2021年恢复到预期水平。按薪酬类别划分的模式与观察到的整体模式相似。在整个大流行期间,非医院分娩总数明显高于预期,有意在家分娩的人数大幅增加。结论:产妇护理的大多数最初变化在整个大流行期间持续存在,并在大流行之后继续存在,导致产前护理就诊水平降低,在家分娩人数增加。这些调查结果表明,2019冠状病毒病促使产妇保健服务的提供和获取发生了持续变化,这突显了产妇服务对医疗保健中断的脆弱性,并表明对公平获得安全护理的长期影响。
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
Reproductive Health
Reproductive Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
6.00
自引率
5.90%
发文量
220
审稿时长
>12 weeks
期刊介绍: Reproductive Health focuses on all aspects of human reproduction. The journal includes sections dedicated to adolescent health, female fertility and midwifery and all content is open access. Reproductive health is defined as a state of physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life. Good reproductive health implies that people are able to have a satisfying and safe sex life, the capability to reproduce and the freedom to decide if, when, and how often to do so. Men and women should be informed about and have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth.
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