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Prospective Survey of Discrimination in Pregnant Persons and Correlation with Unplanned Healthcare Utilization

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Objective

To determine the association between lifetime exposure to discrimination and unplanned healthcare utilization in pregnant persons.

Methods

This was a prospective cohort study of pregnant persons receiving care from 2021 to 2022. Primary data was collected from participants on sociodemographic factors and on Perceived Ethnic Discrimination Questionnaire (PED-Q), a validated 17-item scale measuring perceived lifetime interpersonal racial and ethnic discrimination in four domains: work/school, social exclusion, stigmatization, and threat. The primary outcome was unplanned healthcare utilization, defined as unplanned labor and delivery admissions, triage, Emergency Department, or urgent care visits. Bivariate and multivariate analyses were done to examine the association between lifetime exposure to discrimination and unplanned healthcare utilization.

Results

A total of 289 completed the PED-Q and were included in the analysis. Of these, 123 (42.6%) had unplanned healthcare utilization. Mean (SD) of lifetime racial and ethnic discrimination was significantly higher in people with unplanned healthcare utilization compared to those with planned healthcare utilization [1.67 (0.63) vs 1.48 (0.45), p = 0.003]. Univariate analysis showed that lifetime racial and ethnic discrimination was significantly associated with unplanned healthcare utilization (OR 1.96, 95% CI 0.23–3.11). Significant associations were found between unplanned healthcare utilization and maternal age (p = 0.04), insurance type (p = 0.01), married status (p < 0.001), education (p = 0.013), household income (p = 0.001), and chronic hypertension (p = 0.004). After controlling for potential confounding factors, self-reported lifetime racial and ethnic discrimination remained significantly associated with higher odds of unplanned healthcare utilization (aOR 1.78, CI 95% 1.01–3.11).

Conclusion

We found that a higher level of self-reported lifetime racial and ethnic discrimination was associated with increased unplanned healthcare utilization during pregnancy.

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Data Availability

Data presented in this paper was obtained from individual surveys. Given the sensitive topic studied, consent for data sharing beyond the primary research team was not obtained.

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Author information

Authors and Affiliations

  1. Medical of Wisconsin, Milwaukee, WI, USA

    Rachel Greenberg & Elisha Jaeke

  2. Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA

    Ronald Anguzu

  3. Department of Obstetrics and Gynecology, Medical College of Wisconsin, Wisconsin Ave, Milwaukee, WI, 53226, USA

    Anna Palatnik

  4. Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA

    Anna Palatnik

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  2. Ronald Anguzu
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Rachel Greenberg, Ronald Anguzu, Elisha Jaeke, and Anna Palatnik. The first draft of the manuscript was written by Rachel Greenberg and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anna Palatnik.

Ethics declarations

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Medical College of Wisconsin/Froedtert Hospital Institutional Review Board #5 and with the 1964 Helsinki Declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.

Competing Interests

Dr. Palatnik is supported by the American Heart Association Career Development award 847482 and by NICHD R01 HD108194. The other authors, Rachel Greenberg, Dr. Ronald Anguzu, and Elisha Jaeke have no relevant financial or non-financial interests to disclose.

Additional information

Findings of this study were presented at the 43rd annual meeting of the Society for Maternal–Fetal Medicine, San Francisco, CA, February 6–11, 2023.

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Greenberg, R., Anguzu, R., Jaeke, E. et al. Prospective Survey of Discrimination in Pregnant Persons and Correlation with Unplanned Healthcare Utilization. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01789-x

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