686: Socioeconomic and racial disparities in intensive care level utilization in a national sample

Abstract

The aim of this study is to determine the incidence of intensive care level complications in the postpartum period using a national sample, and to identify racial and socioeconomic disparities among these women. Delivery hospitalizations were abstracted from the 2002-2014 Nationwide Inpatient Sample with intensive care level diagnoses and procedures identified utilizing the NIS’s Clinical Classification Software. Intensive care level proxies, such as septicemia, Swan Ganz catheterization, and mechanical ventilation, were abstracted and collapsed into an intensive care composite. Multivariable log linear regression models were fit to assess the risk of intensive care level diagnoses and procedures with the primary predictors being race (non-Hispanic white, non-Hispanic black, Hispanic, other), payer, and ZIP code income quartile. Sensitivity analyses were conducted on a low risk cohort, excluding patients with placenta accreta spectrum disorders, history of prior cesarean (with and without placenta previa), pre-gestational diabetes, chronic hypertension, lupus, chronic kidney disease, and asthma. 59.9 million deliveries were identified with 80% (n=48.3 million) noted to be low risk with a rate of intensive care complications of 22.7 and 18.8 cases per 10,000 deliveries for all and low-risk deliveries, respectively, with white, privately insured, and higher income quartile patients with lower rates of complications (Table 1). In adjusted analysis, black (RR=1.85, 95% CI 1.82-1.88), Hispanic (RR=1.37, 95% CI 1.35, 1.40), and women of other race (RR=1.55, 95% CI 1.16, 1.20) were at higher risk of intensive care level complications compared to white patients. Similar effects were seen with public insurance and low income quartiles (Table 2). Sensitivity analyses also noted similar results. The risk of complications requiring an intensive level of care in the postpartum period is highest among black and Medicare patients. Awareness of these disparities may lead to improvement in process implementation and additional work in protocol uniformity to reduce these disparities.View Large Image Figure ViewerDownload Hi-res image Download (PPT)