Online Program

Pregnancy Characteristics and Birth Outcomes Among Women with Disabilities Identified Through Medical Claims

Monday, November 2, 2015 : 1:10 p.m. - 1:30 p.m.

Karen Clements, ScD, Center for Health Policy & Research, University of Massachusetts Medical School, Shrewsbury, MA
Monika Mitra, PhD, Lurie Institute for Disability Policy, Heller School of Social Policy and Management, Brandeis University, Waltham, MA
Jianying Zhang, MD, MPH, Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
Background: Women with a self-reported disability have low socioeconomic status (SES) and are at risk for pregnancy complications and poor birth outcomes.   Little is known about underlying disabling diagnoses in this group and the impact of these conditions through pregnancy.  We identified disabilities among pregnant women using hospital claims and evaluated the relationship between claims-defined disability and SES, pregnancy complications, and birth outcomes.

Methods: Data from the 2006-2010 Massachusetts Pregnancy to Early Life Longitudinal data system, (birth certificate and hospital claims), were linked to Pregnancy Risk Assessment Monitoring System survey data.  Access Risk Classification System (ARCS) categorized ICD-9/CPT codes from hospital claims one year pre-pregnancy through birth into disability risk groups (no/limited vs. medium/high).

Results: Among 5899 women with a live birth, 13.7% were classified by ARCS at medium/high risk of disability.  Of disabling conditions, 24% were neoplasms, 20% mental health/central nervous system diagnoses, 8% musculoskeletal diagnoses, and 48% other conditions.  Women at medium/high risk of disability were more likely than those at no/limited risk to live below the federal poverty level (32.4%, 95%CI 27.4%-37.7% vs. 21.1% 95%CI 19.7%-22.6%),  have 1+ pregnancy complication ( 72.1%, 95%CI 67.1%-76.7% vs. 54.5%, 95%CI 52.6%-56.3%), and have a low birthweight infant ( 12.2%, 95%CI 9.2%-16.1% vs. 6.4%, 95%CI 5.6%-7.3%).  

Conclusion: As with self-reported disability, disability identified through claims is associated with lower SES, pregnancy complications, and poor birth outcomes. Future analyses will compare self-reported disability with ARCS disability categories and evaluate the association between specific disabling conditions, pregnancy risk, and outcomes.

Learning Areas:

Provision of health care to the public
Public health or related research

Learning Objectives:
Describe the percentage of women with a live birth who were at medium/high risk of disability as identified by medical claims. Describe disabling conditions in this group. Compare SES, pregnancy complications and birth outcomes between women with and without claims-identified disabilities

Keyword(s): Disabilities, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Research Scientist on the grant, Health Needs and Barriers to Perinatal Care for Women with Mobility Disabilities, which funded the analyses on which the abstract is based. As an epidemiologist and health services researcher with over 10 years experience working with health claims data, I designed the analyses that produced the results for this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.