475 - Private or Public Health Insurance and Infant Outcomes in the United States

Poster Number: 475
Publication Number: 475.129

Desalyn L. Johnson, UAB Heersink School of Medicine, Toney, AL, United States; Waldemar A. Carlo, University of Alabama at Birmingham, Birmingham, AL, United States; AKM F. Rahman, University of Alabama at Birmingham, Vestavia, AL, United States; Rachel Tindal, UAB Heersink School of Medicine, Birmingham, AL, United States; Colm P. Travers, University of Alabama at Birmingham, Birmingham, AL, United States

Background: Disparities in the infant mortality rate (IMR) are associated with race, region, and socioeconomic status. Health insurance status is associated with differences in access to healthcare and health outcomes.

Objective: To determine if maternal private insurance is associated with a lower infant mortality rate compared to public Medicaid insurance in the United States.

Design/Methods: This ecological study used data from the Center for Disease Control and Prevention (CDC) WONDER expanded linked birth and infant death records database 2017-2018. We included hospital-born infants from 20 to 42 weeks of gestational age if the mother had private or Medicaid insurance. We excluded infants with congenital anomalies. We used negative-binomial regression adjusted for race, sex, multiple birth, and any maternal pregnancy risk factors (as defined by the CDC) to determine the difference in IMR between private and Medicaid insurance. Fisher’s exact test was used to compare differences in categorical variables between groups.

Results: We included 6,901,328 infants of whom 3,698,416 (53.6%) had private insurance and 3,202,912 (46.4%) were insured by Medicaid. The private insurance cohort included 334,426 (9.0%) Black infants and the Medicaid cohort included 787,280 (24.6%) Black infants. Infants with private insurance had a lower IMR compared to those with Medicaid (private IMR 2.84/1000 vs. Medicaid IMR 5.32/1000; adjusted relative risk (aRR) 0.71; 95% confidence intervals (CI) 0.62 to 0.81; p< 0.001). Mothers with private insurance had a higher rate of 1st trimester prenatal care compared to mothers with Medicaid insurance (85.6% vs. 66.6%; p< 0.001). Rates of any infant morbidity (13.7/1000 vs. 19.7/1000; p< 0.001) were lower among mothers with private insurance compared to those with Medicaid insurance. Infants with private insurance also had lower rates of preterm birth (9.1% vs. 11.0%; p< 0.001), extremely preterm birth (0.5% vs. 0.7%; p< 0.001), low birth weight birth (7.1% vs. 9.6%; p< 0.001), and extremely low birth weight birth (0.5% vs. 0.7%; p< 0.001) compared to those with Medicaid. Rates of vaginal breech delivery and antenatal corticosteroid exposure did not differ between groups.Conclusion(s): Private insurance is associated with a lower IMR compared with Medicaid insurance. In addition, privately insured pregnancies have higher rates of early prenatal care, less morbidity, and less preterm and low birth weight births.
Johnson_Desalyn_CV_APA_January_2022Johnson_Desalyn_CV_APA_January_2022.pdf