Delivery Payment Source Differences in Infant Mortality Attributable to Birth Defects by Race and Ethnicity-United States, 2011 to 2013 Open Access

Almli, Lynn (2016)

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In the United States (U.S.), 1 in 33 infants are born with a birth defect. Infant mortality attributable to birth defects (IMBD) is the leading cause of infant mortality in the U.S. with 1 in 5 infant deaths resulting from complications from birth defects. IMBD rates differ across neonatal (birth to <28 days) and postneonatal (≥28 days to <1 year) periods and by race and ethnicity. Socioeconomic status (SES) is also hypothesized to affect IMBD, but how SES affects IMBD has not been well-studied. The 2003 revision of the birth certificate included a new variable on health insurance payment source for delivery, a proxy indicator for one aspect of SES. Starting in 2011, the CDC's National Center for Health Statistics added this variable to their data linking birth certificates and infant death certificates. We used data on births from 2011-2013 to examine whether there is an association between IMBD and payment source for delivery and whether the association is modified by racial or ethnic group (non-Hispanic white, non-Hispanic black, and Hispanic). We examined neonatal and postneonatal IMBD separately using Poisson regression to calculate the adjusted rate ratio (aRR) comparing IMBD rates among births covered by Medicaid with those covered by private insurance, adjusting for maternal age. For births covered by Medicaid, the neonatal IMBD rate was 38% higher and the postneonatal IMBD rate was 63% higher compared with births covered by private insurance. All race and ethnic groups had a similar trend of increased IMBD for births covered by Medicaid compared with private insurance, although the postneonatal mortality aRR for infants of non-Hispanic black mothers was slightly attenuated. Our results suggest that Medicaid is associated with higher IMBD rates, particularly during the postneonatal period, and that the association between payment source and IMBD is minimally modified by race and ethnicity. Insurance status could be a marker for SES or for access to health care. Examining the role of additional SES measures and of access to quality care could clarify the reason insurance status is associated with IMBD and help plan intervention strategies to reduce IMBD rates in the U.S.

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