Healthcare Utilization Around the Time of Pregnancy by Extent of Disability in the U.S., 2018–2020

IF 4.7 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine Pub Date : 2026-04-01 Epub Date: 2025-12-04 DOI:10.1016/j.amepre.2025.108211

Andrea L. Deierlein PhD , Hedda L. Boege MS , Lauren T. Berube PhD , Rachel Ryan PhD , Cheryl R. Stein PhD

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引用次数: 0

Abstract

Introduction

Females with disabilities have greater preconception health risks and adverse perinatal outcomes than those without disabilities. Characterization of reproductive healthcare utilization among females with disabilities in the U.S. is limited. We examined healthcare receipt before, during, and after pregnancy by extent of disability among U.S. females with recent live births.

Methods

This cross-sectional study used Pregnancy Risk Assessment Monitoring System data (collected in 2018–2020 and analyzed in 2025) from 24 states that included the Washington Group Short Set of Questions on Disability. Participants self-reported healthcare visits in the year prior to pregnancy, receipt and timing of prenatal care, and receipt of a postpartum checkup. Disability was assessed as extent of difficulty (none, some, and a lot of difficulty). Associations between extent of disability and healthcare utilization were estimated using multivariable modified Poisson regression (adjusted prevalence ratios and 95% CI).

Results

Of 41,210 participants, 34.2% and 6.7% reported some and a lot of difficulty, respectively. Females with some difficulty had higher prevalence (adjusted prevalence ratio range=1.10–1.24) of not having a prepregnancy reproductive healthcare visit, any prenatal care, first trimester prenatal care initiation, and a postpartum checkup than those with no difficulty. Among females with a lot of difficulty, there was similarly elevated prevalence of not having a prepregnancy reproductive healthcare visit or first trimester initiation of prenatal care, but they had a 171% (adjusted prevalence ratio=2.71, 95% CI=1.49, 4.94) and 63% (adjusted prevalence ratio=1.63, 95% CI=1.40, 1.91) higher prevalence of not having any prenatal care and not having a postpartum checkup, respectively, than females with no difficulty.

Conclusions

Females with some and a lot of difficulty reported lower receipt of reproductive, prenatal, and postpartum care than those with no difficulty. Strategies are needed to establish and coordinate comprehensive reproductive health care among females with disabilities.

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2018-2020年美国按残疾程度分列的怀孕前后医疗保健利用情况

前言：残疾女性比无残疾女性有更大的孕前健康风险和不良的围产期结局。美国残疾女性生殖保健利用的特征是有限的。我们检查了美国女性在怀孕前，怀孕期间和怀孕后的残疾程度的医疗收据。方法：这项横断面研究使用了来自24个州的怀孕风险评估监测系统数据（收集于2018-2020年，并于2025年进行分析），其中包括华盛顿小组关于残疾的简短问题集。参与者自我报告怀孕前一年的保健访问情况；产前护理的接收和时间安排；还有产后检查的收据。残疾被评估为困难程度（无困难、有些困难和很多困难）。使用多变量修正泊松回归（调整患病率，aPR和95%置信区间，CI）估计残疾程度与医疗保健利用之间的关联。结果：在41210名参与者中，34.2%和6.7%的人分别报告了一些和很多困难。与无困难的女性相比，有一定困难的女性没有孕前生殖保健访问、任何产前护理、妊娠早期产前护理开始和产后检查的患病率（aPR范围：1.10至1.24）更高。在困难较大的女性中，未进行孕前生殖保健访问或妊娠早期未进行产前保健的患病率也有类似的升高，但未进行产前保健和未进行产后检查的患病率分别比无困难的女性高171% （aPR=2.71, 95% CI: 1.49-4.94）和63% （aPR=1.63, 95% CI: 1.40-1.91）。结论：与无困难的女性相比，有一些困难和很多困难的女性接受生殖、产前和产后护理的比例较低。需要制定战略，在残疾女性中建立和协调全面的生殖保健。

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 Preventive Medicine 医学-公共卫生、环境卫生与职业卫生

CiteScore

8.60

自引率

1.80%

发文量

395

审稿时长

32 days

期刊介绍： The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women''s health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and substance use disorders. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. The journal also publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community.