Title: Comparing Adverse Birth Outcomes Between Patients on Medicaid and Private Insurance
Author(s): Jamie Bosze, MD; Asmau Misawa, MD; Jennifer LaManna, PhD; David Gemmel, PhD
Email: jjbosze@mercy.com
Introduction: In 2020, 53.61% of total births in Ohio were covered by Medicaid, and 46.39% were covered through private insurance. Previous studies have shown patients on private insurance have a lower infant mortality rate as compared to those on Medicaid, and lower incidence of adverse birth outcomes, including preterm delivery and small for gestational age (SGA) infants. The purpose of this study is to ascertain if there were significant differences in the incidence of three adverse outcomes- pre-term birth, SGA infants, and cesarean sections (CS)- between Medicaid and private insurance patients from a local Centering Pregnancy program.
Methods: Data obtained from participants in the Centering Pregnancy program in Youngstown, OH, from 2019-2023 (n= 486). Patient demographics measured included age, race, residential zip code/median income per zip code, insurance provider, number of sessions attended, and birth outcomes (method of delivery, gestational age, infant birth weight). Patients who had no insurance (n=89), attended less than 4 sessions (n=155), or experienced fetal demise (n=3) were excluded. The remainder of patients (n=239) were divided into those on Medicaid (n=203) and those on private insurance (n=36). Demographics and birth outcomes were noted for each group (pre-term birth, CS, and SGA infant) and compared using Chi square analysis. Difference between groups was accounted for in statistics.
Results: Patients on Medicaid had a median age of 26, private insurance patients had a median age of 28. Demographics of Medicaid patients were: 97 African American (47.78%), 59 Caucasian (29.06%), 45 Hispanic (22.17%), 2 other (0.99%). Demographics of private insurance patients were: 15 African American (41.67%), 10 Caucasian (27.78%), 11 Hispanic (30.55%). Median income of Medicaid patients’ residential areas was $24,348, compared to $50,372 for Private insurance. Of those on Medicaid, the incidence of preterm birth was 16.26% (33 out of 203), incidence of delivery by CS was 40.89% (83 out of 203), and the incidence of SGA infants was 17.24% (35 out of 203). Of those on private insurance, the incidence of preterm birth was 5.56% (2 out of 36), incidence of delivery by CS was 33.33% (12 out of 36), and the incidence of infants who were small for gestational age was 22.22% (8 out of 36). There was no statistically significant difference in birth outcomes between Medicaid and private insurance patients.
Discussion: In the population of Centering Pregnancy patients in Youngstown, Ohio, there was no statistically significant difference in birth outcomes between those on Medicaid and private insurance. The residential zip codes of the patients on Medicaid had a lower median income than those who were on private insurance. The two insurance groups were comparable in age. The Medicaid insurance group had a higher proportion of African American patients, and the private insurance group had a higher percentage of Hispanic patients. The proportion of Caucasian patients in each insurance group was comparable.
