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Pregnancy and Emergency Department Utilization in North Carolina, 2016–2021: A Population-Based Surveillance Study
INTRODUCTION: Pregnancy-associated complaints are a common reason for emergency department visits for women of reproductive age. Emergency department utilization during pregnancy is associated with worse birth outcomes for both mothers and infants. We used statewide North Carolina emergency departme...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546499/ https://www.ncbi.nlm.nih.gov/pubmed/37790954 http://dx.doi.org/10.1016/j.focus.2023.100142 |
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author | Nazzal, Elizabeth M. Waller, Anna E. Meyer, Michelle L. Ising, Amy I. Jones-Vessey, Kathleen Urrutia, Eugene Urrutia, Rachel P. |
author_facet | Nazzal, Elizabeth M. Waller, Anna E. Meyer, Michelle L. Ising, Amy I. Jones-Vessey, Kathleen Urrutia, Eugene Urrutia, Rachel P. |
author_sort | Nazzal, Elizabeth M. |
collection | PubMed |
description | INTRODUCTION: Pregnancy-associated complaints are a common reason for emergency department visits for women of reproductive age. Emergency department utilization during pregnancy is associated with worse birth outcomes for both mothers and infants. We used statewide North Carolina emergency department surveillance data between 2016 and 2021 to describe the sociodemographic factors associated with the use of emergency department for pregnancy-associated problems and subsequent hospital admission. METHODS: North Carolina Disease Event Tracking and Epidemiologic Collection Tool is a syndromic surveillance system that includes all emergency department encounters at civilian acute-care facilities in North Carolina. We analyzed all emergency department visits between January 1, 2016 and December 31, 2021 for female patients aged 15–44 years residing in North Carolina with at least 1 ICD-10-CM code (analysis occurred in July 2021–October 2022). Each emergency department visit was categorized as pregnancy-associated if assigned ICD-10-CM code(s) indicated pregnancy. We stratified visits by age, race, ethnicity, county of residence, and insurance and compared them with estimated pregnant population proportions using 1-sample t-tests. We used multivariable logistic regression to determine whether pregnancy-associated visits were more likely to be associated with hospital admission and then to determine sociodemographic predictors of admission among pregnancy-associated emergency department visits. RESULTS: More than 6.4 million emergency department visits were included (N=6,471,197); 10.1% (n=655,476) were pregnancy-associated, significantly higher than the proportion of women estimated to be pregnant at any given time in North Carolina (4.6%, p<0.0001) and increased over time (8.6% in 2016 vs 11.1% in 2021, p<0.0001). Pregnancy-associated visits were lower than expected for ages 25–44 years and higher than expected for those aged 15–24 years, for those of Black race, and for patients residing in rural or suburban areas. The proportion admitted was higher for pregnancy-associated emergency department visits than for nonpregnancy associated (15.6% vs 7.0%, AOR=3.06 [95% CI=3.03, 3.09]). Pregnancy-associated emergency department visits for patients of Black race had 0.58 times (95% CI=0.57, 0.59) the odds of admission compared with White patients. CONCLUSIONS: Emergency department utilization during pregnancy is common. The proportion of pregnancy-associated emergency department visits among reproductive-age women is increasing, as are inpatient admissions from the emergency department for pregnancy-associated diagnoses. Use of public health surveillance databases such as the North Carolina Disease Event Tracking and Epidemiologic Collection Tool may help identify opportunities for improving disparities in maternal health care, especially related to access to care. |
format | Online Article Text |
id | pubmed-10546499 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-105464992023-10-03 Pregnancy and Emergency Department Utilization in North Carolina, 2016–2021: A Population-Based Surveillance Study Nazzal, Elizabeth M. Waller, Anna E. Meyer, Michelle L. Ising, Amy I. Jones-Vessey, Kathleen Urrutia, Eugene Urrutia, Rachel P. AJPM Focus Research Article INTRODUCTION: Pregnancy-associated complaints are a common reason for emergency department visits for women of reproductive age. Emergency department utilization during pregnancy is associated with worse birth outcomes for both mothers and infants. We used statewide North Carolina emergency department surveillance data between 2016 and 2021 to describe the sociodemographic factors associated with the use of emergency department for pregnancy-associated problems and subsequent hospital admission. METHODS: North Carolina Disease Event Tracking and Epidemiologic Collection Tool is a syndromic surveillance system that includes all emergency department encounters at civilian acute-care facilities in North Carolina. We analyzed all emergency department visits between January 1, 2016 and December 31, 2021 for female patients aged 15–44 years residing in North Carolina with at least 1 ICD-10-CM code (analysis occurred in July 2021–October 2022). Each emergency department visit was categorized as pregnancy-associated if assigned ICD-10-CM code(s) indicated pregnancy. We stratified visits by age, race, ethnicity, county of residence, and insurance and compared them with estimated pregnant population proportions using 1-sample t-tests. We used multivariable logistic regression to determine whether pregnancy-associated visits were more likely to be associated with hospital admission and then to determine sociodemographic predictors of admission among pregnancy-associated emergency department visits. RESULTS: More than 6.4 million emergency department visits were included (N=6,471,197); 10.1% (n=655,476) were pregnancy-associated, significantly higher than the proportion of women estimated to be pregnant at any given time in North Carolina (4.6%, p<0.0001) and increased over time (8.6% in 2016 vs 11.1% in 2021, p<0.0001). Pregnancy-associated visits were lower than expected for ages 25–44 years and higher than expected for those aged 15–24 years, for those of Black race, and for patients residing in rural or suburban areas. The proportion admitted was higher for pregnancy-associated emergency department visits than for nonpregnancy associated (15.6% vs 7.0%, AOR=3.06 [95% CI=3.03, 3.09]). Pregnancy-associated emergency department visits for patients of Black race had 0.58 times (95% CI=0.57, 0.59) the odds of admission compared with White patients. CONCLUSIONS: Emergency department utilization during pregnancy is common. The proportion of pregnancy-associated emergency department visits among reproductive-age women is increasing, as are inpatient admissions from the emergency department for pregnancy-associated diagnoses. Use of public health surveillance databases such as the North Carolina Disease Event Tracking and Epidemiologic Collection Tool may help identify opportunities for improving disparities in maternal health care, especially related to access to care. Elsevier 2023-08-13 /pmc/articles/PMC10546499/ /pubmed/37790954 http://dx.doi.org/10.1016/j.focus.2023.100142 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Research Article Nazzal, Elizabeth M. Waller, Anna E. Meyer, Michelle L. Ising, Amy I. Jones-Vessey, Kathleen Urrutia, Eugene Urrutia, Rachel P. Pregnancy and Emergency Department Utilization in North Carolina, 2016–2021: A Population-Based Surveillance Study |
title | Pregnancy and Emergency Department Utilization in North Carolina, 2016–2021: A Population-Based Surveillance Study |
title_full | Pregnancy and Emergency Department Utilization in North Carolina, 2016–2021: A Population-Based Surveillance Study |
title_fullStr | Pregnancy and Emergency Department Utilization in North Carolina, 2016–2021: A Population-Based Surveillance Study |
title_full_unstemmed | Pregnancy and Emergency Department Utilization in North Carolina, 2016–2021: A Population-Based Surveillance Study |
title_short | Pregnancy and Emergency Department Utilization in North Carolina, 2016–2021: A Population-Based Surveillance Study |
title_sort | pregnancy and emergency department utilization in north carolina, 2016–2021: a population-based surveillance study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546499/ https://www.ncbi.nlm.nih.gov/pubmed/37790954 http://dx.doi.org/10.1016/j.focus.2023.100142 |
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