ABSTRACT
OBJECTIVE: The objective is to determine the association between maternal race/ethnicity, insurance, education level, and pregnancy outcomes. METHODS: We queried the U.S. vital statistics records from 2015 to 2019 to analyze all deliveries. Using a multivariate analysis model, we determined the interaction between maternal race, insurance, education, and pregnancy outcomes. The outcome measures were the 5-min Apgar score, neonatal unit admission, neonates receiving assisted ventilation > 6 hours, mothers requiring blood transfusion, and the intensive care unit admission. RESULT: There were 13,213,732 deliveries that met our inclusion criteria. In the study population, 52.7% were white, 14.1% blacks, 22.9% Hispanics, and 10.4% belonged to other races. 37.5% of the women had a high school education, 49.1% had a college education, and 12.3% had advanced degrees. Black mothers with high school education were more likely to require blood transfusion following delivery than Whites at the same education level, OR=1.08 (95% CI 1.05-1.11, p < 0.05). They were also more likely to be admitted into intensive care. The difference only disappeared among blacks with advanced education (OR=1.0; 95% CI 0.89-1.12, p > 0.05). Across all races/ethnicities, private insurance and advanced education were associated with better pregnancy outcomes. CONCLUSION: In the U.S., women with high socioeconomic status have better pregnancy outcomes across all races/ethnicities.
ABSTRACT
Objective To evaluate the demographic predictors of major depressive disorder (MDD) in hospitalized congestive heart failure (CHF) patients and measure the differences in hospital stay and cost per comorbidities and the associated risk of in-hospital mortality. Methods This retrospective cross-sectional study used nationwide inpatient data from the healthcare cost and utilization project (HCUP). We identified patients with CHF as the primary diagnosis and MDD as the secondary diagnosis using ICD-9-CM codes and compared with the CHF patient without MDD. The differences in comorbidities were quantified using chi-square tests and the logistic regression model was used to evaluate mortality risk among comorbidities using odds ratio (OR). Results Elder CHF patients, 36-50-year-old (OR: 1.324) and whites (OR: 1.673), have a higher likelihood of a co-diagnosis of MDD. Females with heart failure have two-fold higher odds of MDD (OR: 2.332). Majority of the medical comorbidities were seen in a higher proportion of CHF patients without MDD. Hypothyroidism (10.2%) and drug abuse (15.2%) were seen more in depressed patients comparatively. Among substance use disorder, patients with drug abuse stayed longer and had a higher hospitalization total cost ($51,828). And, hypothyroidism was associated with longer inpatient stay (5.6 days) and cost ($64,726), and four-fold higher odds of in-hospital mortality (OR: 4.405). Though alcohol abuse was seen only in 7.4% of CHF patients with MDD, it was associated with the three-fold higher likelihood of deaths during hospitalization (OR: 3.195). Conclusion A middle-aged, white female with comorbid depression has a higher risk of hospitalization for heart failure. Depressed CHF patients with comorbid hypothyroidism were hospitalized for a longer duration with higher inpatient cost and four times higher risk of mortality during hospitalization stay. Further studies are required to evaluate the underlying cause of worse hospital outcomes in depressed CHF patients with alcohol abuse and hypothyroidism. An integrated healthcare model is required for early diagnosis and treatment of depression and associated comorbidities in CHF patients to reduce mortality and improve post-CHF outcomes.
