Risking life to give life: epidemiology and costs of severe maternal morbidity in the United States
Creators: name: Black, Christopher M.
Publisher: name: No Publisher Supplied
Year: 2019

description: Background: Approximately four million children are born in the United States each year and childbirth are the most common reason for hospitalization. Rates of severe maternal morbidity (SMM), life threatening events occurring childbirth, have been increasing over the past 20 years in the United States. Few studies have examined the epidemiology of SMM and gaps still exist. Specific Aims: The goal of this dissertation is to understand the epidemiologic and economic burden of severe maternal morbidity (SMM) in the United States using administrative claims data. This study aims to answer three research questions: 1) What is the incidence of SMM in 2016? 2) What is the incidence rate and predictors of unplanned 30-day hospital readmissions and emergency room (ER) visits after a delivery hospitalization among women with and without SMM? and 3) What are the associated healthcare resource utilization costs associated with SMM across the prenatal, delivery, and postpartum period? Methods: This was a retrospective cohort study of women with a live inpatient delivery during 2016 in the MarketScan databases for commercially insured and Medicaid populations. The incidence of severe maternal morbidity and the frequencies of 18 individual SMM indicators, as defined by the Center for Disease Control &amp; Prevention’s algorithm of ICD-10 diagnostic and procedural codes was calculated. Incidence rates of 30-day hospital readmissions and treat-and-release ER visits were calculated and compared for women with and without SMM. Healthcare costs during the prenatal, delivery and 30-day post-delivery period were estimated and compared by SMM status. Results: The incidence of severe maternal morbidity was 113.4 per 10,000 deliveries in the Commercial population and 109.6 per 10,000 deliveries in the Medicaid population. The most frequent severe maternal morbidity indicators were eclampsia, blood transfusion and disseminated intravascular coagulation (35.0 and 25.7 per 10,000 deliveries) in the Commercial population and eclampsia and adult respiratory distress syndrome (45.5 and 14.9 per 10,000 deliveries) in the Medicaid population. In the multivariate analysis, a cesarean delivery and multifetal gestation was associated with severe maternal morbidity in both Commercial (OR 3.37; 95% CI 1.51, 1.84; OR: 3.37; 95%CI 2.8, 4.10) and Medicaid populations (OR 1.99; 95%CI 1.80, 2.17; OR: 2.26; 95%CI: 1.86, 2.75). Race was also associated with an increased risk of SMM (White vs Black OR:0.78; 95%CI: 0.70, 0.87). There were 1,972 hospital readmissions and 132 ER visits in the commercially-insured population with incidence rates of 11.7 and 0.8 per 1,000 discharges. These rates were 12 and 19 times greater for women with SMM than women without SMM. In the Medicaid population there were 1,114 hospital readmissions and 119 ER visits, for incidence rates of 17.0 and 1.8 per 1,000 discharges. SMM increased these rates by 16 and 17 times for hospital readmission and ER visits, respectively. Eclampsia was the most commonly reported SMM indicator among women with a hospital readmission or ER visit in both populations. Hypertensive disorders during pregnancy and eclampsia, obstetric infections and hemorrhage were common reasons for a hospital readmission and ER visits. SMM was associated with many of the primary discharge diagnoses for hospital readmissions and ER visits. In the Commercial population, the total, per-patient mean costs of care for women without and with SMM were $23,144 and $47,030, respectively, with prenatal, delivery and post-delivery costs all significantly higher among women with SMM. The adjusted delivery cost for women with SMM were 20% greater than women without SMM. In the Medicaid population, the total, per-patient mean costs of care for women with and without SMM were $26,513 vs $9,652, respectively. The adjusted delivery cost for women with SMM were 31% greater than women without SMM. Conclusion: Preventing SMM would result in significant reductions in healthcare resource utilization and associated costs and would reduce an undue burden to mothers, healthcare providers, hospital administrators, and payers.