Associations between unstable housing, obstetric outcomes, and perinatal health care utilization

Matthew S Pantell; Rebecca J Baer; Jacqueline M Torres; Jennifer N Felder; Anu Manchikanti Gomez; Brittany D Chambers; Jessilyn Dunn; Nisha I Parikh; Tania Pacheco-Werner; Elizabeth E Rogers; Sky K Feuer; Kelli K Ryckman; Nicole L Novak; Karen M Tabb; Jonathan Fuchs; Larry Rand; Laura L Jelliffe-Pawlowski

doi:10.1016/j.ajogmf.2019.100053

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Associations between unstable housing, obstetric outcomes, and perinatal health care utilization

Journal article

Open access

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Associations between unstable housing, obstetric outcomes, and perinatal health care utilization

Matthew S Pantell, Rebecca J Baer, Jacqueline M Torres, Jennifer N Felder, Anu Manchikanti Gomez, Brittany D Chambers, Jessilyn Dunn, Nisha I Parikh, Tania Pacheco-Werner, Elizabeth E Rogers, …

American journal of obstetrics & gynecology MFM, Vol.1(4), pp.100053-100053

11/2019

DOI: 10.1016/j.ajogmf.2019.100053

PMID: 33345843

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Abstract

While there is a growing interest in addressing social determinants of health in clinical settings, there are limited data on the relationship between unstable housing and both obstetric outcomes and health care utilization. The objective of the study was to investigate the relationship between unstable housing, obstetric outcomes, and health care utilization after birth. This was a retrospective cohort study. Data were drawn from a database of liveborn neonates linked to their mothers' hospital discharge records (2007-2012) maintained by the California Office of Statewide Health Planning and Development. The analytic sample included singleton pregnancies with both maternal and infant data available, restricted to births between the gestational age of 20 and 44 weeks, who presented at a hospital that documented at least 1 woman as having unstable housing using the International Classification of Diseases, ninth edition, codes (n = 2,898,035). Infants with chromosomal abnormalities and major birth defects were excluded. Women with unstable housing (lack of housing or inadequate housing) were identified using International Classification of Diseases, ninth edition, codes from clinical records. Outcomes of interest included preterm birth (<37 weeks' gestational age), early term birth (37-38 weeks gestational age), preterm labor, preeclampsia, chorioamnionitis, small for gestational age, long birth hospitalization length of stay after delivery (vaginal birth, >2 days; cesarean delivery, >4 days), emergency department visit within 3 months and 1 year after delivery, and readmission within 3 months and 1 year after delivery. We used exact propensity score matching without replacement to select a reference population to compare with the sample of women with unstable housing using a one-to-one ratio, matching for maternal age, race/ethnicity, parity, prior preterm birth, body mass index, tobacco use during pregnancy, drug/alcohol abuse during pregnancy, hypertension, diabetes, mental health condition during pregnancy, adequacy of prenatal care, education, and type of hospital. Odds of an adverse obstetric outcome were estimated using logistic regression. Of 2794 women with unstable housing identified, 83.0% (n = 2318) had an exact propensity score-matched control. Women with an unstable housing code had higher odds of preterm birth (odds ratio, 1.2, 95% confidence interval, 1.0-1.4, P < .05), preterm labor (odds ratio, 1.4, 95% confidence interval, 1.2-1.6, P < .001), long length of stay (odds ratio, 1.6, 95% confidence interval, 1.4-1.8, P < .001), emergency department visits within 3 months (odds ratio, 2.4, 95% confidence interval, 2.1-2.8, P < .001) and 1 year after birth (odds ratio, 2.7, 95% confidence interval, 2.4-3.0, P < .001), and readmission within 3 months (odds ratio, 2.7, 95% confidence interval, 2.2-3.4, P < .0014) and 1 year after birth (odds ratio, 2.6, 95% confidence interval, 2.2-3.0, P < .001). Unstable housing documentation is associated with adverse obstetric outcomes and high health care utilization. Housing and supplemental income for pregnant women should be explored as a potential intervention to prevent preterm birth and prevent increased health care utilization.

preterm birth

unstable housing

social determinants of health

homelessness

socioeconomic status

Details

Title: Subtitle: Associations between unstable housing, obstetric outcomes, and perinatal health care utilization
Creators: Matthew S Pantell - Department of Pediatrics, University of California, San Francisco; California Preterm Birth Initiative, University of California, San Francisco. Electronic address: Matt.Pantell@ucsf.edu
Rebecca J Baer - California Preterm Birth Initiative, University of California, San Francisco; Department of Pediatrics, University of California, San Diego, San Diego, CA
Jacqueline M Torres - Department of Epidemiology and Biostatistics, University of California, San Francisco; California Preterm Birth Initiative, University of California, San Francisco
Jennifer N Felder - California Preterm Birth Initiative, University of California, San Francisco
Anu Manchikanti Gomez - School of Social Welfare, University of California, Berkeley, Berkeley, CA
Brittany D Chambers - Department of Epidemiology and Biostatistics, University of California, San Francisco; California Preterm Birth Initiative, University of California, San Francisco
Jessilyn Dunn - Department of Biomedical Engineering, Duke University, Durham, NC
Nisha I Parikh - Division of Cardiology, Department of Medicine, University of California, San Francisco
Tania Pacheco-Werner - Central Valley Health Policy Institute, California State University, Fresno, Fresno, CA
Elizabeth E Rogers - Department of Pediatrics, University of California, San Francisco; California Preterm Birth Initiative, University of California, San Francisco
Sky K Feuer - California Preterm Birth Initiative, University of California, San Francisco
Kelli K Ryckman - Department of Epidemiology, University of Iowa, Iowa City, IA
Nicole L Novak - Department of Community and Behavioral Health, University of Iowa, Iowa City, IA
Karen M Tabb - School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL
Jonathan Fuchs - San Francisco Department of Public Health, San Francisco, CA
Larry Rand - Obstetrics and Gynecology, University of California, San Francisco; California Preterm Birth Initiative, University of California, San Francisco
Laura L Jelliffe-Pawlowski - Department of Epidemiology and Biostatistics, University of California, San Francisco; California Preterm Birth Initiative, University of California, San Francisco
Resource Type: Journal article
Publication Details: American journal of obstetrics & gynecology MFM, Vol.1(4), pp.100053-100053
DOI: 10.1016/j.ajogmf.2019.100053
PMID: 33345843
ISSN: 2589-9333
eISSN: 2589-9333
Grant note: DOI: 10.13039/100005595, name: University of California; name: Preterm Birth Initiative
Language: English
Date published: 11/2019
Academic Unit: Stead Family Department of Pediatrics; Epidemiology; Public Policy Center (Archive); Community and Behavioral Health
Record Identifier: 9984214724502771

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