A population-based analysis of postpartum acute care use among women with disabilities

Abstract

Background: Disability is common in reproductive-aged women, and as many as 1 in 8 pregnancies occur in women with a disability. Women with disabilities experience significant social and health disparities, and are at greater risk than their nondisabled counterparts for perinatal complications. Yet, few studies have examined their postpartum acute care use.

Objective: To examine risks of postpartum emergency department visits and hospital admissions among women with and without physical, sensory, and intellectual/developmental disabilities.

Study design: In this population-based study in Ontario, Canada, women with a singleton obstetrical delivery from 2003 to 2019 were classified into those with physical (n=155,500), sensory (n=49,338), intellectual/developmental (n=2650), and multiple disabilities (≥2 disabilities; n=9904), and women without disabilities (n=1,701,574). Primary outcomes were emergency department visits and hospital admissions 0 to 365 days after index delivery hospital discharge. Secondary outcomes were emergency department visits and hospital admissions by primary diagnosis (medical, psychiatric) and by timing (0-7, 8-42, 43-365 days postpartum). Adjusted relative risks comparing each disability group to those without disabilities were adjusted for age; parity; income quintile; rurality; immigrant/refugee status; prepregnancy chronic medical conditions, mental illness, and substance use disorders; and prenatal care provider type.

Results: Any postpartum emergency department visit occurred in 23.5% of women without a disability, with risks elevated in women with physical (32.9%; adjusted relative risk, 1.27; 95% confidence interval, 1.26-1.28), sensory (30.0%; adjusted relative risk, 1.16; 95% confidence interval, 1.15-1.18), intellectual/developmental (48.8%; adjusted relative risk, 1.38; 95% confidence interval, 1.33-1.44), and multiple disabilities (42.0%; adjusted relative risk, 1.44; 95% confidence interval, 1.41-1.48) compared with women without disabilities. Similarly, any postpartum hospital admission occurred in 3.0% of women without a disability, with elevated risks in women with physical (4.8%; adjusted relative risk, 1.37; 95% confidence interval, 1.34-1.40), sensory (4.0%; adjusted relative risk, 1.19; 95% confidence interval, 1.14-1.24), intellectual/developmental (9.6%; adjusted relative risk, 1.96; 95% confidence interval, 1.73-2.21), and multiple disabilities (7.3%; adjusted relative risk, 1.77; 95% confidence interval, 1.64-1.90). Results were consistent by primary diagnosis and timing in the postpartum period.

Conclusion: Women with disabilities have elevated risk of emergency department visits and hospital admissions in the postpartum period, indicating greater postpartum morbidity, which requires attention through enhanced and extended follow-up across the postpartum period.

Keywords: disabled persons; emergency service; hospital; maternal health; maternal health services; postnatal care; postpartum period; support for persons with disabilities.

Figure 1.. Risk of (a) medical and (b) psychiatric emergency department visits, by timing, in women with a disability, compared to women without any recognized disability.

CI = confidence interval; IDD = intellectual/developmental disability; RR = relative risk. Adjusted model includes maternal age, parity, neighborhood income quintile, region of residence, immigrant/refugee status, stable and unstable chronic conditions, type 1 or type 2 diabetes, chronic hypertension or cardiovascular disease, mental illness, substance use disorders, and type of prenatal care provider.

Figure 2.. Number of emergency department visits between 0 and 365 days postpartum, in women with a disability, compared to women without any recognized disability.

CI = confidence interval; IDD = intellectual/developmental disability; RR = relative risk. Adjusted model includes maternal age, parity, neighborhood income quintile, region of residence, immigrant/refugee status, stable and unstable chronic conditions, type 1 or type 2 diabetes, chronic hypertension or cardiovascular disease, mental illness, substance use disorders, and type of prenatal care provider.

Figure 3.. Risk of (a) medical and (b) psychiatric hospital admissions, by timing, in women with a disability, compared to women without any recognized disability.

CI = confidence interval; IDD = intellectual/developmental disability; RR = relative risk. Adjusted model includes maternal age, parity, neighborhood income quintile, region of residence, immigrant/refugee status, stable and unstable chronic conditions, type 1 or type 2 diabetes, chronic hypertension or cardiovascular disease, mental illness, substance use disorders, and type of prenatal care provider.

Figure 4.. Number of hospital admissions between 0 and 365 days postpartum, in women with a disability, compared to women without any recognized disability.

CI = confidence interval; IDD = intellectual/developmental disability; RR = relative risk. Adjusted model includes maternal age, parity, neighborhood income quintile, region of residence, immigrant/refugee status, stable and unstable chronic conditions, type 1 or type 2 diabetes, chronic hypertension or cardiovascular disease, mental illness, substance use disorders, and type of prenatal care provider.