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Disparities in Chronic Conditions Among Women Hospitalized for Delivery in the United States, 2005–2014

Admon, Lindsay K. MD; Winkelman, Tyler N. A. MD, MSc; Moniz, Michelle H. MD, MSc; Davis, Matthew M. MD, MAPP; Heisler, Michele MD, MPA; Dalton, Vanessa K. MD, MPH

doi: 10.1097/AOG.0000000000002357
Contents: Original Research

OBJECTIVE: To estimate trends in the prevalence and socioeconomic distribution of chronic conditions among women hospitalized for obstetric delivery in the United States.

METHODS: A retrospective, serial cross-sectional analysis was conducted using 2005–2014 data from the National Inpatient Sample. We estimated the prevalence of eight common, chronic conditions, each associated with obstetric morbidity and mortality, among all childbearing women and then across socioeconomic predictors of obstetric outcomes. Differences over time were measured and compared across rural and urban residence, income, and payer subgroups for each condition.

RESULTS: We identified 8,193,707 delivery hospitalizations, representing 39,273,417 delivery hospitalizations occurring nationally between 2005 and 2014. Identification of at least one chronic condition increased significantly between 2005–2006 and 2013–2014 (66.9 per 1,000 delivery hospitalizations in 2005–2006 compared with 91.8 per 1,000 delivery hospitalizations in 2013–2014). The prevalence of multiple chronic conditions also increased during the study period, from 4.7 (95% CI 4.2–5.2) to 8.1 (95% CI 7.8–8.4) per 1,000 delivery hospitalizations between 2005–2006 and 2013–2014. Chronic respiratory disease, chronic hypertension, substance use disorders, and pre-existing diabetes were the disorders with the greatest increases in prevalence over time. Increasing disparities over time were identified across all socioeconomic subgroups analyzed including rural compared with urban residence, income, and payer. Key areas of concern include the rate at which substance use disorders rose among rural women and the disproportionate burden of each condition among women from the lowest income communities and among women with Medicaid as their primary payer.

CONCLUSION: Between 2005–2006 and 2013–2014, the prevalence of chronic conditions increased across all segments of the childbearing population. Widening disparities were identified over time with key areas of concern including disproportionate, progressive increases in the burden of chronic conditions among women from rural and low-income communities and those with deliveries funded by Medicaid.

Chronic conditions are increasingly prevalent among childbearing women, and the largest increases in prevalence are occurring among women in rural and low-income communities and among those with deliveries funded by Medicaid.

National Clinician Scholars Program, at the Institute for Healthcare Policy and Innovation at the University of Michigan and the US Department of Veterans Affairs, Ann Arbor, Michigan; the Departments of Obstetrics & Gynecology, Internal Medicine, Health Behavior & Health Education, and the Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, Michigan; the Departments of Internal Medicine and Pediatrics, Hennepin County Medical Center, and the Center for Patient and Provider Experience, Minneapolis Medical Research Foundation, Minneapolis, Minnesota; the Departments of Pediatrics, Medicine, Medical Social Sciences, and Preventive Medicine, Northwestern Feinberg School of Medicine and the Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois.

Corresponding author: Lindsay K. Admon, MD, University of Michigan North Campus Research Center, 2800 Plymouth Road, Building 14, Room G100-36, Ann Arbor, MI 48109-2800; email:

Supported by the National Clinician Scholars Program. Michele Heisler is supported by National Institutes of Health Grant P30 DK092926.

Financial Disclosure Dr. Dalton is an expert witness for Bayer. The other authors did not report any potential conflicts of interest.

Presented at the Congress on Women's Health, April 28–30, 2017, Washington, DC; the American College of Obstetricians and Gynecologists’ Annual Clinical and Scientific Meeting, May 6–9, 2017, San Diego, California; and the AcademyHealth Annual Research Meeting, June 25–27, 2017, New Orleans, Louisiana.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.