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Reduced rate of postpartum readmissions among homeless compared with non-homeless women in New York: a population-based study using serial, cross-sectional data
  1. Rie Sakai-Bizmark1,2,
  2. Hiraku Kumamaru3,
  3. Dennys Estevez1,
  4. Sophia Neman1,
  5. Lauren E M Bedel1,
  6. Laurie A Mena1,
  7. Emily H Marr1,
  8. Michael G Ross1,4,5
  1. 1The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
  2. 2Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
  3. 3Department of Healthcare Quality Assessment, The University of Tokyo School of Medicine, Tokyo, Japan
  4. 4Department of Obstetrics & Gynecology, Harbor-UCLA Medical Center, Torrance, CA, USA
  5. 5Department of Obstetrics & Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
  1. Correspondence to Dr Rie Sakai-Bizmark, Pediatrics, The Lundquist Institute, Torrance, CA 90502, USA; rsakaibizmark{at}ucla.edu

Abstract

Objective To assess differences in rates of postpartum hospitalisations among homeless women compared with non-homeless women.

Design Cross-sectional secondary analysis of readmissions and emergency department (ED) utilisation among postpartum women using hierarchical regression models adjusted for age, race/ethnicity, insurance type during delivery, delivery length of stay, maternal comorbidity index score, other pregnancy complications, neonatal complications, caesarean delivery, year fixed effect and a birth hospital random effect.

Setting New York statewide inpatient and emergency department databases (2009–2014).

Participants 82 820 and 1 026 965 postpartum homeless and non-homeless women, respectively.

Main outcome measures Postpartum readmissions (primary outcome) and postpartum ED visits (secondary outcome) within 6 weeks after discharge date from delivery hospitalisation.

Results Homeless women had lower rates of both postpartum readmissions (risk-adjusted rates: 1.4% vs 1.6%; adjusted OR (aOR) 0.87, 95% CI 0.75 to 1.00, p=0.048) and ED visits than non-homeless women (risk-adjusted rates: 8.1% vs 9.5%; aOR 0.83, 95% CI 0.77 to 0.90, p<0.001). A sensitivity analysis stratifying the non-homeless population by income quartile revealed significantly lower hospitalisation rates of homeless women compared with housed women in the lowest income quartile. These results were surprising due to the trend of postpartum hospitalisation rates increasing as income levels decreased.

Conclusions Two factors likely led to lower rates of hospital readmissions among homeless women. First, barriers including lack of transportation, payment or childcare could have impeded access to postpartum inpatient and emergency care. Second, given New York State’s extensive safety net, discharge planning such as respite and sober living housing may have provided access to outpatient care and quality of life, preventing adverse health events. Additional research using outpatient data and patient perspectives is needed to recognise how the factors affect postpartum health among homeless women. These findings could aid in lowering readmissions of the housed postpartum population.

  • obstetrics and gynaecology
  • health services research
  • womens health

Data availability statement

No data are available. HCUP requires researchers to sign Data Use Agreements (DUAs) before data are released to them. This DUA prohibits sharing or re-release of individual-level data. However, aggregate statistics and the statistical analysis plan are available.

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Data availability statement

No data are available. HCUP requires researchers to sign Data Use Agreements (DUAs) before data are released to them. This DUA prohibits sharing or re-release of individual-level data. However, aggregate statistics and the statistical analysis plan are available.

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Footnotes

  • Twitter @SakaiBizmark

  • Contributors RS-B conceptualised and designed the study, developed the models, contributed to data interpretation, drafted the initial manuscript and revised the manuscript. HK conceptualised and designed the study, developed the models, contributed to data interpretation and the discussion section, and reviewed and revised the manuscript. DE and SN performed data analyses, contributed to data interpretation, created the figures, and reviewed and revised the manuscript. LEMB conducted literature searches, created the tables, contributed to the introduction and discussion sections, and reviewed and revised the manuscript. LAM and EHM conducted literature searches and reviewed and revised the manuscript. MGR supervised the study overall, confirmed interpretation of the results, and critically reviewed and revised the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding RS-B had financial support from National Institutes of Health (NIH) Research Scientist Development Award (NHLBI K01HL141697) for the submitted work.

  • Disclaimer The contents of this work are solely the responsibility of the authors and do not represent the official views of the National Heart, Lung, and Blood Institute.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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