Postpartum Readmission in Maryland by Race and Ethnicity, 2016-2019

• Published in: AJOG global reports 2023-11, Vol.3 (4), p.100278-100278, Article 100278
• Main Authors: HAMILTON, Ms. Sonia, OLSON, Sarah, VOEGTLINE, Kristin, LAWSON, Shari M
• Format: Article
• Language: English
• Subjects: care delay; healthcare disparities; hypertensive disorders of pregnancy; maternal morbidity and mortality; Original Research; postpartum care; public health
• ISSN: 2666-5778; 2666-5778
• DOI: 10.1016/j.xagr.2023.100278

Background: The majority of maternal deaths occur in the postpartum period. We sought to compare postpartum readmission by race and ethnicity to better understand whether there are disparities in maternal health in the postpartum period as indicated by readmission to the hospital. Objectives: To use state-wide Maryland data to identify postpartum readmission rates by race and ethnicity, as well as the major risk factors, indications, and timing of readmission. Study Design: In this retrospective study (2016-2019), childbirth hospitalizations for patients of childbearing age were identified from the Maryland State Inpatient Database (SID), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Indication for readmission was described. Multivariable logistic regression models were employed to determine racial and ethnic differences in postpartum readmissions, adjusting for maternal and obstetric characteristics. Results: Among total deliveries (n=260,778), 3,914 patients (1.5%) were readmitted within 60 days of delivery. The most common primary diagnoses at readmission were hypertension and infection. The prevalence of readmission was 1.2% (1,306/111,325) for White patients, 2.3% (1,786/79,412) for Black patients, 1.2% (485/40,862) for Hispanic patients and 1.2% (337/29,179) for patients of Other race or ethnicity (p< 0.0001). Black patients had the highest rates of readmission for hypertensive disorders as compared to all other races (37%, p< 0.0001). In adjusted models, Black patients were more likely to be readmitted than White patients (OR 1.64, CI 1.52-1.77). The majority of all readmissions occurred in the first week after delivery with Black patients having higher rates of readmission in the second week relative to all other groups (p< 0.0001). Conclusions: Hypertension is a leading factor for postpartum readmission in Maryland. Black patients were more likely to be readmitted for hypertensive disorders of pregnancy and to have delayed readmission relative to other race/ethnic groups. Maryland public health officials should address disparities with interventions targeting racial and ethnic minorities, patients at risk for hypertensive disorders, and barriers to timely care.