Rural/urban differences in health care utilization and costs by perinatal depression status among commercial enrollees

Details

• Alternative Title:
  J Rural Health
• Personal Author:
  Pollack, Lisa M. ; Chen, Jiajia ; Cox, Shanna ; Luo, Feijun ; Robbins, Cheryl L. ; Tevendale, Heather ; Li, Rui ; Ko, Jean Y.
• Description:
  Purpose:
  
  To 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.
  
  Methods:
  
  We 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.
  
  Findings:
  
  Ten 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).
  
  Conclusions:
  
  Commercially 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.
  
  
• Subjects:
  Depression Female Health Expenditures Humans Insurance, Health Patient Acceptance Of Health Care Pregnancy Rural Population
• Source:
  J Rural Health. 40(1):26-63
• Pubmed ID:
  37467110
• Pubmed Central ID:
  PMC10796846
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  40
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:2494b60691585c93be250c98ed4275fe86c7f7ac2274bb72c4e862b08ee459b17af75f9b6c8cee37bf987a231bcdffdae232ed1d038f3a56d514ea6d3cc6c415
• Download URL:
  https://stacks.cdc.gov/view/cdc/145951/cdc_145951_DS1.pdf
• File Type:
  [PDF - 693.79 KB ]