163: Disparities in obstetric readmissions: A multistate analysis, 2007-2014

Abstract

Hospital readmissions are an area of focus in reducing cost and improving quality of healthcare. Readmission rates are generally higher among racial-ethnic minorities and patients of lower socioeconomic status, however this has not been widely studied in the obstetric population. Our objective was to determine 30-day readmission rates after vaginal and cesarean delivery by race-ethnicity, median income and insurance payer status (social determinants of health; SDH). Using State Inpatient Databases (SID) from the Healthcare Cost and Utilization Project (HCUP) from 2007-2014, we queried all cases with a singleton or multiple birth listed. To produce accurate estimates of the effects of parturients’ SDH on readmission odds, while controlling for confounders at the patient-, hospital- and procedure-level, generalized linear mixed models were used. Interaction models were generated for each combination of the three SDH variables of interest to highlight any associations and their effect on the outcome. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) are reported. There were 5,129,867 deliveries with 79,260 (1.5%) 30-day readmissions in the administrative record. Of these, 947 (0.8%) were missing reported race-ethnicity. Of the remaining cases, Black and Hispanic patients were more likely to be readmitted within 30 days of delivery, as compared to White patients (p< 0.0001). Patients in the 2nd quartile of median income were more likely to be readmitted than those living in other quartiles (p< 0.05). Patients with Medicare or Medicaid were also more likely to be readmitted than those with private insurance (p< 0.0001). Table 1 shows aORs for significant interaction terms. Significant racial-ethnic disparities in obstetric readmissions were observed, particularly in patients with government insurance and even in those living in the highest quartile of median income. Next steps include identification of diagnoses by race-ethnicity, with the goal of focusing interventions on those diagnoses, meanwhile taking into account individual SDH.