Unequal Uptake: Insurance-Related Disparities in Prenatal Genetic Counseling and Screening at a Quaternary Medical Center.

Abstract

The purpose of this study was to evaluate the association between the type of insurance coverage and the uptake of prenatal genetic counseling and aneuploidy screening. This was a retrospective analysis of pregnant people who sought prenatal care at a quaternary medical system from August 1, 2017 to August 29, 2019. The primary exposure was insurance status, while the outcomes of interest were the uptake of genetic counseling and aneuploidy screening. Characteristics of the four insurance coverage groups were compared using simple comparisons and multivariable logistic regression models estimating odds of receiving genetic counseling and screening. A total of 8774 births were included. There were significant differences among insurance groups in race, ethnicity, language, parity, and gestational age at the first visit. Pregnant people differed significantly by payer status with regard to the uptake of both counseling and aneuploidy screening. In adjusted models, those without insurance or who were self-paid were significantly less likely to have genetic counseling and aneuploidy screening as compared to those with public or private insurance. In adjusted models, those who were older, spoke English, and were in their first pregnancy were significantly more likely to receive genetic counseling and aneuploidy screening. This analysis contributes to the understanding of how insurance mechanisms within the United States can contribute to the uptake of prenatal genetic counseling and screening. However, there is a complex interplay between payer status and other patient-level characteristics such as age, language, and timing of initiation of prenatal care. Future studies that assess both system-level and patient-level characteristics are crucial.