Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system

Min Kyoung Kim,Jin Yong Lee,Seung Mi Lee,Min-Woo Jo,Hyun Joo Kim,Sung-Hee Bae,Nam Gu Lim,Seok-Jun Yoon

doi:10.1186/s12939-017-0715-7

Abstract

BackgroundLow socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. Korea has been adopting a universal healthcare system. All Korean citizens must be enrolled National Health Insurance (NHI) or be recipient of Medical Aid (MA). In addition, Korean government launched a financial support system for antenatal care for all pregnant women in 2008. Therefore, in theory, there is no financial barrier to receive prenatal cares regardless of someone’s social class. However, it is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. The purpose of this study was to investigate whether socioeconomic status affects pregnancy outcomes after the introduction of this support system, which allows all pregnant women to receive adequate prenatal care regardless of socioeconomic status.MethodsUsing the National Health Insurance database in Korea, we selected women who gave birth between January 1, 2010 and December 31, 2010. As a proxy indicator reflecting socioeconomic status, we classified subjects as MA recipient (“low” SES) or a NHI beneficiary (“middle/high” SES).ResultsIn the MA group, 29.4% women received inadequate prenatal care, compared to 11.4% in the NHI group. Mothers in the MA group were more likely to have an abortion (30.1%), rather than deliver a baby, than those in the NHI group (20.7%, P < 0.001). Mothers in the MA group were also more likely to undergo a Caesarean delivery (45.8%; NHI group: 39.6%, P < 0.001), and have preeclampsia (1.5%; NHI group: 0.6%, P < 0.001), obstetric hemorrhage (4.7%; NHI group: 3.9%, P = 0.017), and a preterm delivery (2.1%; NHI group: 1.4%, P < 0.001) than those in the NHI group.ConclusionsWomen in the MA group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery, and obstetrical hemorrhage than those in the NHI group Therefore, health authorities should consider investigating what kind of barriers exist or what factors may affect these inequitable outcomes.

Highlights

Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care
Women in the Medical Aid (MA) group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery, and obstetrical hemorrhage than those in the National Health Insurance (NHI) group health authorities should consider investigating what kind of barriers exist or what factors may affect these inequitable outcomes
To compare the NHI and MA groups, their basic health status was adjusted; that is, if there were differences in pregnancy-related indicators (PRIs), we considered the effect of their basic health status

Summary

Introduction

Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. In theory, there is no financial barrier to receive prenatal cares regardless of someone’s social class It is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. Inadequate prenatal care is associated with poor obstetric outcomes, including preterm delivery, preeclampsia, and stillbirth [1, 4,5,6,7], and women with low SES are less likely to receive prenatal care [1, 2, 8]. The risk of preterm delivery, preeclampsia, and gestational diabetes increases with both inadequate prenatal care and low SES [3,4,5]

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