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Racial and Ethnic Disparities in Postpartum Care in the Greater Boston Area During the COVID-19 Pandemic.
Mi, Tianyue; Hung, Peiyin; Li, Xiaoming; McGregor, Alecia; He, Jingui; Zhou, Jie.
  • Mi T; Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia.
  • Hung P; Center for Anesthesia Innovation and Quality, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
  • Li X; Department of Health Services Policy and Management, University of South Carolina, Columbia.
  • McGregor A; Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia.
  • He J; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Zhou J; Center for Anesthesia Innovation and Quality, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Netw Open ; 5(6): e2216355, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1898499
ABSTRACT
Importance Racial and ethnic disparities in postpartum care access have been well identified in the United States. Such disparities could be exacerbated by the COVID-19 pandemic because of amplified economic distress and compromised social capital among pregnant women who belong to racial or ethnic minority groups.

Objective:

To examine whether the COVID-19 pandemic is associated with an increase in the existing racial and ethnic disparity in postpartum care access. Design, Setting, and

Participants:

This was a retrospective cohort study using electronic health records data. Multinomial logistic regressions in an interrupted time series approach were used to assess monthly changes in postpartum care access across Asian, Hispanic, non-Hispanic Black (hereafter, Black), non-Hispanic White (hereafter, White) women, and women of other racial groups, controlling for maternal demographic and clinical characteristics. Eligible participants were women who gave live birth at 8 hospitals in the greater Boston, Massachusetts, area from January 1, 2019, to November 30, 2021, allowing for tracking 90-day postpartum access until March 1, 2022. Exposures Delivery period prepandemic (January to December 2019), early pandemic (January to March 2020), and late pandemic (April 2020 to November 2021). Main Outcomes and

Measures:

Postpartum care within 90 days after childbirth was categorized into 3 groups attended, canceled, and nonscheduled.

Results:

A total of 45 588 women were included. Participants were racially and ethnically diverse (4735 [10.4%] Asian women, 3399 [7.5%] Black women, 6950 [15.2%] Hispanic women, 28 529 [62.6%] White women, and 1269 [2.8%] women of other race or ethnicity). The majority were between 25 and 34 years of age and married and had a full-term pregnancy, vaginal delivery, and no clinical conditions. In the prepandemic period, the overall postpartum care attendance rate was 75.2%, dropping to 41.7% during the early pandemic period, and rebounding back to 60.9% in the late pandemic period. During the months in the late pandemic, the probability of not scheduling postpartum care among Black (average marginal effect [AME], 1.1; 95% CI, 0.6-1.6) and Hispanic women (AME, 1.3; 95% CI, 0.9-1.6) increased more than among their White counterparts. Conclusions and Relevance In this cohort study of postpartum care access before and during the COVID-19 pandemic, racial and ethnic disparities in postpartum care were exacerbated following the onset of the COVID-19 pandemic, when postpartum care access recovered more slowly among Black and Hispanic women than White women. These disparities require swift attention and amelioration to address barriers for these women to obtain much needed postpartum care during this pandemic.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Ethnicity / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Male / Pregnancy Country/Region as subject: North America Language: English Journal: JAMA Netw Open Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Ethnicity / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Male / Pregnancy Country/Region as subject: North America Language: English Journal: JAMA Netw Open Year: 2022 Document Type: Article