Perinatal Uninsurance More Likely for Rural Residents

Uninsurance increased during prepregancy, birth, postpartum for rural residents versus urban counterparts

WEDNESDAY, Feb. 8, 2023 (HealthDay News) — During the perinatal period, uninsurance is more common among rural than urban residents, according to a study published online Feb. 2 in Obstetrics & Gynecology.

Lindsay K. Admon, M.D., from the University of Michigan in Ann Arbor, and colleagues conducted a pooled, cross-sectional analysis of survey data from 154,992 postpartum individuals in 43 states and two jurisdictions. Unadjusted estimates of insurance coverage were calculated during prepregnancy, birth, and postpartum periods, and insurance continuity across these periods was assessed among rural and urban U.S. residents.

The researchers found that the odds of uninsurance in each period and of continuous uninsurance across all three periods were greater for rural residents than their urban counterparts. During prepregnancy, birth, and postpartum, uninsurance was higher among rural versus urban residents (adjusted odds ratios, 1.19, 1.60, and 1.27, respectively). Greater adjusted odds of uninsurance were seen for rural residents who were non-Hispanic White, were married, and had intended pregnancies compared with their urban counterparts in each period. Persistent rural-urban differences in uninsurance were seen across both Medicaid expansion and nonexpansion states and among those with varying levels of education and income.

“Insurance coverage represents the first step in the pathway toward accessing high-quality perinatal care,” the authors write. “It is imperative that further policy attention be directed toward the inequities in access to and receipt of care, including through perinatal insurance coverage, faced by rural residents.”

Abstract/Full Text

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