Affiliation:
1. Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta Georgia USA
2. Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta Georgia USA
3. Division of Research Office of Epidemiology and Research Health Resources and Services Administration Maternal and Child Health Bureau US Department of Health and Human Services Rockville Maryland USA
4. Commissioned Corps United States Public Health Service United States Department of Health and Human Services Rockville Maryland USA
Abstract
AbstractPurposeTo understand differences in health care utilization and medical expenditures by perinatal depression (PND) status during pregnancy and 1‐year postpartum overall and by rural/urban status.MethodsWe estimated differences in health care utilization and medical expenditures by PND status for individuals with an inpatient live‐birth delivery in 2017, continuously enrolled in commercial insurance from 3 months before pregnancy through 1‐year postpartum (study period), using MarketScan Commercial Claims data. Multivariable regression was used to examine differences by rurality.FindingsTen percent of commercially insured individuals had claims with PND. A smaller proportion of rural (8.7%) versus urban residents (10.0%) had a depression diagnosis (p < 0.0001). Of those with PND, a smaller proportion of rural (5.5%) versus urban residents (9.6%) had a depression claim 3 months before pregnancy (p < 0.0001). Compared with urban residents, rural residents had greater differences by PND status in total inpatient days (rural: 0.7, 95% confidence interval [CI]: 0.6–0.9 vs. urban: 0.5, 95% CI: 0.5–0.6) and emergency department (ED) visits (rural: 0.7, 95% CI: 0.6–0.9 vs. urban: 0.5, 95% CI: 0.4–0.5), but a smaller difference by PND status in the number of outpatient visits (rural: 9.2, 95% CI: 8.2–10.2 vs. urban: 13.1, 95% CI: 12.7–13.5). Differences in expenditures for inpatient services by PND status differed by rural/urban status (rural: $2654; 95% CI: $1823–$3485 vs. urban: $1786; 95% CI: $1445–$2127).ConclusionsCommercially insured rural residents had more utilization for inpatient and ED services and less utilization for outpatient services. Rural locations can present barriers to evidence‐based care to address PND.
Subject
Public Health, Environmental and Occupational Health