Objective: Medicaid insures over 40% of the deliveries in the United States, and many of the insureds are at higher risk of poor pregnancy outcomes.1 To determine whether this population is also at greater risk for cesarean delivery, we explore whether insurance type is associated with method of delivery. Since delivery practices vary by location and hospital, it is important to explore this association on a smaller scale. Thus, the objective of this study was to look at the association between insurer and method of delivery among individuals who delivered their babies at hospitals within the county Westchester County, New York.
Methods: Data for births occurring in Westchester County, New York, from 2011-2017 were obtained from the New York State Statewide Planning and Research Cooperative System (SPARCS). The primary exposure, Medicaid insurance, was considered for its impact on the primary outcome of cesarean delivery. Prevalence ratios were estimated using log binomial regression. We assessed whether the association between insurer and delivery method was modified by race, age, and delivery hospital, and controlled for confounding by mortality risk.
Results: Westchester County births for the period totaled 68,719, with 40 percent delivered by cesarean section, and 42 percent covered by Medicaid. For all cesarean deliveries, 98 percent were of minor mortality risk, the lowest risk category. There was no effect modification by age of the association between Medicaid and cesarean deliveries. Black, Other and White race categories showed a small inverse association between Medicaid and cesarean delivery. There was moderate inverse association between Medicaid and cesarean delivery for six hospitals. One hospital had a small positive association between Medicaid and cesarean section.
Conclusion: Since the prevalence of cesarean deliveries is greater in marginalized populations, which includes those more likely to be insured by Medicaid, we expected results to show a positive association between Medicaid and cesarean section. However, in some racial groups and some hospitals, we found a small to moderate negative association between Medicaid and cesarean section. Further exploration of this topic should include identified data to adequately analyze age and race and to examine whether any common comorbidities impact this association.
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