Karen M Clements1, Jianying Zhang2, Linda M Long-Bellil3, Monika Mitra2. 1. Commonweatlh Medicine Division, University of Massachusetts Medical School, United States; Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States. Electronic address: Karen.clements@umassmed.edu. 2. Lurie Institute For Disability Policy, Heller School for Social Policy and Management, Brandeis University, United States. 3. Commonweatlh Medicine Division, University of Massachusetts Medical School, United States.
Abstract
BACKGROUND: Women with disabilities are at risk for poor birth outcomes. Little is known about longer-term health and healthcare utilization of infants of women with disabilities. OBJECTIVES: We identified women at risk for disability and evaluated their infants' emergency department (ED) utilization during the first year of life. STUDY DESIGN: This population-based cohort study used Massachusetts 2007-2009 birth certificates linked to 2007-2010 hospital discharge data. Access Risk Classification System categorized ICD-9 CM/CPT codes into disability risk categories. Infant ED visits were evaluated overall and by severity (emergent/intermediate vs. non-emergent). Cox proportional hazards models provided adjusted estimates. Results were stratified by gestational age (preterm, < 37 weeks, term, 37 + weeks). RESULTS: Of 218,599 women, 6.7% were at risk of disability. Infants born to women at risk had a higher rate of ED visits in their first year than infants born to women not at risk: 0.85 visits/person-year (95% CI 0.84-0.87) vs. 0.55 (0.55-0.55) for term, 0.74 (0.70-0.77) vs. 0.55 (0.54-0.56) for preterm. Utilization varied by maternal diagnosis. Emergent/intermediate and non-emergent visits were both elevated among infants born to women at risk for disability. In adjusted analyses, term infants of women with musculoskeletal diagnoses (HR = 1.3, 95% CI 1.2-1.4) and preterm infants of women with circulatory diagnoses (HR = 1.2, 1.0-1.3) had the highest hazards of ED visit vs. infants of women not at risk of disability. CONCLUSION: Maternal disability risk is associated with postnatal infant ED utilization; utilization varies by maternal diagnosis. Interventions to improve health of infants born to women with disabilities are warranted.
BACKGROUND: Women with disabilities are at risk for poor birth outcomes. Little is known about longer-term health and healthcare utilization of infants of women with disabilities. OBJECTIVES: We identified women at risk for disability and evaluated their infants' emergency department (ED) utilization during the first year of life. STUDY DESIGN: This population-based cohort study used Massachusetts 2007-2009 birth certificates linked to 2007-2010 hospital discharge data. Access Risk Classification System categorized ICD-9 CM/CPT codes into disability risk categories. Infant ED visits were evaluated overall and by severity (emergent/intermediate vs. non-emergent). Cox proportional hazards models provided adjusted estimates. Results were stratified by gestational age (preterm, < 37 weeks, term, 37 + weeks). RESULTS: Of 218,599 women, 6.7% were at risk of disability. Infants born to women at risk had a higher rate of ED visits in their first year than infants born to women not at risk: 0.85 visits/person-year (95% CI 0.84-0.87) vs. 0.55 (0.55-0.55) for term, 0.74 (0.70-0.77) vs. 0.55 (0.54-0.56) for preterm. Utilization varied by maternal diagnosis. Emergent/intermediate and non-emergent visits were both elevated among infants born to women at risk for disability. In adjusted analyses, term infants of women with musculoskeletal diagnoses (HR = 1.3, 95% CI 1.2-1.4) and preterm infants of women with circulatory diagnoses (HR = 1.2, 1.0-1.3) had the highest hazards of ED visit vs. infants of women not at risk of disability. CONCLUSION: Maternal disability risk is associated with postnatal infant ED utilization; utilization varies by maternal diagnosis. Interventions to improve health of infants born to women with disabilities are warranted.
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