Abstract
BackgroundProvision of postpartum care can support new families in adapting to a new situation. We aimed to determine whether various determinants of socioeconomic status (SES) were associated with utilization of postpartum care. In addition, to stress the relevance of increasing postpartum care uptake among low SES-groups, an assessment of the potential (cost-)effectiveness of postpartum care is required.MethodsNational retrospective cohort study using linked routinely collected healthcare data from all registered singleton deliveries (2010–13) in the Netherlands. Small-for-gestational age and preterm babies were excluded. The associations between SES and postpartum care uptake, and between uptake and health care expenditure were studied using multivariable regression analyses.ResultsOf all 569 921 deliveries included, 1.2% did not receive postpartum care. Among women who did receive care, care duration was below the recommended minimum of 24 h in 15.3%. All indicators of low SES were independently associated with a lack in care uptake. Extremes of maternal age, single parenthood and being of non-Dutch origin were associated with reduced uptake independent of SES determinants. No uptake of postpartum care was associated with maternal healthcare expenses in the highest quartile: aOR 1.34 (95% CI 1.10–1.67). Uptake below the recommended amount was associated with higher maternal and infant healthcare expenses: aOR 1.09 (95% CI 1.03–1.18) and aOR 1.20 (95% CI 1.13–1.27), respectively.ConclusionAlthough uptake was generally high, low SES women less often received postpartum care, this being associated with higher subsequent healthcare expenses. Strategies to effectively reduce these substantial inequities in early life are urgently needed.
Highlights
The postpartum period is a critical transitional period for babies and in the lives of new mothers.[1]
Using a national linked dataset of over half a million singleton pregnancies, we found that all indicators of low socioeconomic status (SES) were associated with no uptake of postpartum care and with uptake of care below the recommended minimum
This lack of postpartum care uptake was associated with higher healthcare expenses in the first year after childbirth
Summary
The postpartum period is a critical transitional period for babies and in the lives of new mothers.[1]. Conclusion: uptake was generally high, low SES women less often received postpartum care, this being associated with higher subsequent healthcare expenses. CA has been linked to violent offending, limited research has considered adolescent psychiatric disorder as a mediating factor. The current study examined whether adolescent psychiatric disorder mediates the association between CA and violent offending. Individuals exposed to 4+ CAs who were treated for psychiatric disorder had a 12-fold elevated risk for violent offending (adjusted IRR 12.2, 95% CI 10.6–14.0). Conclusions: CA is associated with elevated risk for violent offending in early adulthood, and the association is partly mediated by adolescent psychiatric disorder. Individuals exposed to cumulative CA who develop adolescent psychopathology should be regarded as a high-risk group for violent offending, by professionals in social and health services that come into contact with this group
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