Population-based study on the effect of socioeconomic factors and race on management and outcomes of 35,535 inpatient ectopic pregnancies

Abstract

Study objective: To evaluate whether socioeconomic variables influence the management and outcomes of ectopic pregnancies.

Design: Retrospective cohort study (Canadian Task Force classification II-2).

Setting: Hospitals in the United States participating in the Health Care Cost and Utilization Project.

Patients: Women (n = 35 535) with a primary discharge diagnosis of ectopic pregnancy.

Interventions: Effect of socioeconomic factors and race/ethnicity on management and adverse outcomes of ectopic pregnancy.

Measurements and main results: During the 9-year study, 35 535 ectopic pregnancies were identified. The development of hemoperitoneum in 8706 patients (24.50%) was the most common complication. Asian race was the sociodemographic variable most predictive of hemoperitoneum (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.24-1.61; p < .01) and transfusion (OR, 1.62; 95% CI, 1.39-1.89; p < .01), and Medicare status was most influential on prolonged hospitalization (OR, 1.83; 95% CI, 1.36-2.47; p < .01). Major complications were not affected by socioeconomic factors. Laparotomy in 25 075 patients (70.6%) was the most common treatment option. Patients of Asian or Pacific Islander descent were least likely to be treated non-surgically (OR, 0.62; 95% CI, 0.51-0.76; p < .01), whereas Medicare recipients were most likely to be treated non-surgically (OR, 1.70; 95% CI, 1.32-2.18; p < .01). All non-white groups were less likely to undergo a laparoscopic approach.

Conclusion: Major complications from ectopic pregnancy are not influenced by socioeconomic variables; however, less serious complications and management approaches are persistently affected.

Keywords: Ectopic pregnancy; Management; Outcomes; Socioeconomic factors.