Racial and Ethnic Disparities in Hospital Readmissions After Delivery

Abstract

Objective: To examine 30-day readmission rates after vaginal and cesarean delivery by race-ethnicity and insurance status.

Methods: We analyzed hospital discharge data contained in a statewide database maintained by the Connecticut Department of Public Health. Discharge data for patients admitted for vaginal delivery without complication (n=167,857) and cesarean delivery without complication (n=75,552) from 2005 to 2012 were analyzed using marginal logistic models for clustered data with generalized estimating equations.

Results: Results from logistic models indicated that 30-day readmission rates per 1,000 patients were significantly higher among black (28.9/1,000; confidence interval [CI] 25.5-32.7) and Hispanic women (21.4/1,000; CI 18.9-24.2) than among white women (12.9/1,000; CI 11.9-14.0) after cesarean delivery. Similarly higher rates of readmission were observed for black (14.6/1,000; CI 13.0-16.5) and Hispanic women (10.7/1,000; CI 9.6-12.0) relative to white women (7.5/1,000; CI 7.0-8.1) after vaginal delivery. Rates of 30-day readmission were significantly higher (odds ratio 1.27-1.30) among those covered by Medicaid. Controlling for patient socioeconomic status, comorbidities, and payer did not substantially reduce race and ethic differences in the odds of readmission.

Conclusion: Significant racial and ethnic disparities in readmissions were observed for procedures related to childbirth using a statewide database capturing all payers across all acute care hospital settings. Compared with white women, black women were twice as likely and Hispanic women 40-50% more likely to be readmitted within 30 days of vaginal or cesarean delivery.

Level of evidence: II.