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Medicaid pregnancy termination funding and racial disparities in congenital anomaly-related infant deaths.

Abstract：

OBJECTIVE:To explore whether state restrictions on Medicaid funding for pregnancy termination of anomalous fetuses could be contributing to the black-white disparity in infant death resulting from congenital anomalies. METHODS:Data on deaths resulting from anomalies were obtained from U.S. vital statistics records (1983-2004) and the Nationwide Inpatient Sample (2003-2007). We conducted an ecological study using Poisson and logistic regression to explore the association between state Medicaid funding for pregnancy terminations of anomalous fetuses and infant death resulting from anomalies by calendar time, race, and individual Medicaid status. RESULTS:Since 1983, a gap in anomaly-related infant death has developed between states without compared with those with Medicaid funding for pregnancy termination (rate ratio in 2004 1.21, 95% confidence interval [CI] 1.18-1.24; crude risks: 146.8 compared with 121.7/100,000). Blacks were significantly more likely than whites to be on Medicaid (60.2% compared with 29.2%) and to live in a state without Medicaid funding for pregnancy termination (65.8% compared with 59.6%). The increased risk of anomaly-related death associated with lack of state Medicaid funding for pregnancy termination was most pronounced among black women on Medicaid (relative risk 1.94, 95% CI 1.52-2.36; crude risks: 245.5 compared with 129.3/100,000). CONCLUSION:States without Medicaid funding for pregnancy termination of anomalous fetuses have higher rates of infant death resulting from anomalies than those with funding, and this difference is most pronounced among black women on Medicaid. Restrictions on Medicaid funding for termination of anomalous fetuses potentially could be contributing to the black-white disparity in anomaly-related infant death. LEVEL OF EVIDENCE:II.

journal_name

Obstet Gynecol

journal_title

Obstetrics and gynecology

authors

Hutcheon JA,Bodnar LM,Simhan HN

doi

10.1097/AOG.0000000000000583

subject

Has Abstract

pub_date

2015-01-01 00:00:00

pages

163-169

issue

eissn

0029-7844

issn

1873-233X

pii

00006250-201501000-00027

journal_volume

125

pub_type

杂志文章

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Medicaid pregnancy termination funding and racial disparities in congenital anomaly-related infant deaths.