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首页> 外文期刊>Preventive Medicine: An International Journal Devoted to Practice and Theory >Disparities in infant mortality by payment source for delivery in the United States
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Disparities in infant mortality by payment source for delivery in the United States

机译：通过付款来源在美国递送的婴儿死亡率

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摘要

In this study, we hypothesized that infant mortality varies among health insurance status. Furthermore, we examined whether there are racial and ethnic disparities in the association between infant death and payment source for delivery. Our study used US national linked birth and infant death data for 2013 and 2017 collected by the National Center for Health Statistics and included 3,311,504 and 3,218,168 live births for each year. The principal source of payment for delivery was classified into three groups: Medicaid, private insurance, and self payment. The outcome measures were infant mortality, neonatal mortality, and postneonatal mortality. Subgroup analysis for race and ethnicity was also performed. Overall infant mortality was lower in mothers who paid with private insurance than in those who paid with Medicaid insurance (RR = 0.87, 95% CI 0.84?0.90 in 2013; RR = 0.91, 95% CI 0.87?0.94 in 2017), but it was higher in self-paid women than in Medicaid-insured women at delivery (RR = 1.25, 95% CI 1.17?1.33 in 2013; RR = 1.16, 95% CI 1.08?1.24 in 2017). Non-Hispanic black (RR = 1.67, 95% CI 1.47?1.90 in 2013; RR = 1.16, 95% CI 1.00?1.35 in 2017) and Hispanic (RR = 1.30, 95% CI 1.17?1.44 in 2013; RR = 1.22, 95% CI 1.09?1.36 in 2017) mothers with self-payment had a higher risk for infant mortality than those with Medicaid at delivery. Newborns whose mothers have no health insurance would be more vulnerable to infant mortality than Medicaid beneficiaries, and non-white ethnic groups with self-payment would have an elevated risk of infant mortality among other racial and ethnic groups.
机译：在这项研究中，我们假设婴儿死亡率因医疗保险状况而异。此外，我们还研究了婴儿死亡与分娩支付来源之间的关联是否存在种族和民族差异。我们的研究使用了美国国家卫生统计中心收集的2013年和2017年与美国全国相关的出生和婴儿死亡数据，包括每年3311504和3218168例活产。分娩费用的主要来源分为三类：医疗补助、私人保险和自付。结果指标为婴儿死亡率、新生儿死亡率和新生儿后死亡率。还进行了种族和民族的亚组分析。使用私人保险支付的母亲的总体婴儿死亡率低于使用医疗补助保险支付的母亲（2013年，RR=0.87，95%可信区间0.84？0.90；2017年，RR=0.91，95%可信区间0.87？0.94），但在分娩时，自费妇女的婴儿死亡率高于医疗补助保险妇女（2013年，RR=1.25，95%可信区间1.17？1.33；2017年，RR=1.16，95%可信区间1.08？1.24）。非西班牙裔黑人（2013年RR=1.67，95%可信区间为1.47-1.90；2017年RR=1.16，95%可信区间为1.00-1.35）和西班牙裔（2013年RR=1.30，95%可信区间为1.17-1.44；2017年RR=1.22，95%可信区间为1.09-1.36）产妇在分娩时的婴儿死亡率高于医疗补助。母亲没有医疗保险的新生儿比医疗补助受益人更容易导致婴儿死亡，而在其他种族和族裔群体中，自费的非白人族裔群体的婴儿死亡风险更高。

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