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

Abstract

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.