ArticleJournal of public health management and practice : JPHMP
Demographic Variation in Prenatal Care Coordination Receipt and Resulting Birth Outcomes: Evidence From the Wisconsin Medicaid Population.
Article in Journal of public health management and practice : JPHMP. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
contextMedicaid-funded obstetric care coordination services improve birth outcomes. Whether these benefits vary by race/ethnicity or urbanicity is uncertain.
objectiveWe examined whether the associations between Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program and birth outcomes varied by race/ethnicity and urbanicity.
designData came from a statewide cohort of birth records and linked Medicaid claims. The treatment was PNCC receipt during pregnancy for the birthing parent (none; assessment/care plan; service receipt). Covariate-adjusted conventional and sibling fixed effects linear probability models computed associations between PNCC treatment and birth outcome risks. We stratified models on birthing parent race/ethnicity (American Indian/Alaska Native non-Hispanic [NH]; Asian/Pacific Islander NH; Black NH; Hispanic; White NH; multiple NH; other NH) or on residence county urbanicity (large central metro; large fringe metro; medium metro; small metro; micropolitan; noncore).
settingWisconsin, US.
participantsA total of 249 502 Medicaid-paid births (2010-2019).
main outcome measuresPreterm birth (PTB; gestational age <37 weeks). Low birth weight (LBW; <2500 g).
resultsBias-limiting sibling fixed effects estimates indicated that PNCC's benefit is greatest among Black NH births and large central metro births. For Black NH births, PNCC service receipt was associated with a 3.3 percentage point (pp) reduction (95% CI: -4.5, -2.1pp) and a -2.9pp reduction (95% CI: -4.0, -1.7pp) in the risks of PTB and LBW, respectively. For large central metro births, PNCC service receipt was associated with a 2.7pp reduction (95% CI: -3.7, -1.7pp) and a -2.4pp reduction (95% CI: -3.4, -1.5pp) in the risks of PTB and LBW, respectively.
conclusionsEstimates suggest that PNCC services were most effective in Black NH and urban populations. This motivates policy to improve PNCC outreach and impact in populations that stand to benefit from care coordination during pregnancy.
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