(321) Perinatal Risk and Outcomes Among Individuals insured by Medicare

Insurance status is associated with health outcomes among the general and obstetric populations. This work examines the medical conditions and perinatal outcomes for Medicare insured individuals relative to non-Medicare insured individuals.


Study Design:
We performed a retrospective cohort study using 2019 Healthcare Cost & Utilization Project National Inpatient Sample. We included singleton deliveries without fetal anomalies. Analyses used NIS discharge weights, strata, and hospital clusters to generate nationally representative estimates. We compared Medicare with other payer groups across maternal demographics (age and race), selected chronic medical conditions, and perinatal outcomes including severe maternal morbidity, SMM (defined by the CDC). P values for all outcomes compare the Medicare population with all other payers combined and a two-sided α < 0.05 indicated statistical significance.

Results:

The cohort included 3,697,605 deliveries, of which 28,855 deliveries were insured by Medicare. Delivering persons covered by Medicare were more likely to be Black (33.3% vs 9.5%; p< 0.001) and advanced maternal age (25.6% vs 23.4%; p< 0.001) when compared to those with private insurance. Medicare insured individuals were more likely to have chronic kidney disease (11.89% vs 9.01%; p< 0.001), congestive heart disease (1.39% vs 0.14%; p< 1), pre-pregnancy diabetes (13.27% vs 9.53%; p < 0.001), and pre-pregnancy HTN (9.91% vs 3.09; p< 0.001). Medicare insurance status was associated with higher rates of cesarean delivery (37.7% vs 35.1%; p< 0.001) and preterm birth (13.6% vs 7.5%; p< 0.001). Medicare status was associated with increased relative risk for severe maternal morbidity (SMM) when compared to privately insured individuals (0.28; CI 0.25 – 0.32).


Conclusion:

Reproductive age individuals with Medicare insurance are more likely to enter pregnancy with chronic conditions. Medicare insured individuals were more likely to experience adverse perinatal outcomes. This highlights the need for increased investment in strategies to better support this vulnerable population.