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Risking life to give life: epidemiology and costs of severe maternal morbidity in the United States

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Title
Risking life to give life: epidemiology and costs of severe maternal morbidity in the United States
Name (type = personal)
NamePart (type = family)
Black
NamePart (type = given)
Christopher M.
NamePart (type = date)
1987-
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Christopher M. Black
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RoleTerm (authority = RULIB)
author
Name (type = personal)
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Schneider
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Dona
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Dona Schneider
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Advisory Committee
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chair
Name (type = personal)
NamePart (type = family)
Ohman-Strickland
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Pamela
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Pamela Ohman-Strickland
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Advisory Committee
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internal member
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Advisory Committee
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internal member
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Vesco
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Kimberly
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Kimberly Vesco
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Advisory Committee
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outside member
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Rutgers University
Role
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degree grantor
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School of Graduate Studies
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school
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Text
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theses
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2019
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2019-05
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2019
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English
Abstract (type = abstract)
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 & 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.
Subject (authority = local)
Topic
Epidemiology
Subject (authority = RUETD)
Topic
Public Health
Subject (authority = LCSH)
Topic
Childbirth -- 21st century
Subject (authority = LCSH)
Topic
Pregnant women -- Diseases -- Epidemiology -- 21st century
RelatedItem (type = host)
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Rutgers University Electronic Theses and Dissertations
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ETD_9816
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1 online resource (x, 133 pages) : illustrations
Note (type = degree)
Ph.D.
Note (type = bibliography)
Includes bibliographical references
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School of Graduate Studies Electronic Theses and Dissertations
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rucore10001600001
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Identifier (type = doi)
doi:10.7282/t3-r2hp-4668
Genre (authority = ExL-Esploro)
ETD doctoral
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The author owns the copyright to this work.
RightsHolder (type = personal)
Name
FamilyName
Black
GivenName
Christopher
Role
Copyright Holder
RightsEvent
Type
Permission or license
DateTime (encoding = w3cdtf); (qualifier = exact); (point = start)
2019-04-11 22:01:34
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Name
Christopher Black
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Affiliation
Rutgers University. School of Graduate Studies
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Author Agreement License
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I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
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2019-05-31
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2019-11-30
Detail
Access to this PDF has been restricted at the author's request. It will be publicly available after November 30th, 2019.
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Copyright protected
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Open
Reason
Permission or license
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