Emergency department utilization during the first year of life among infants born to women at risk of disability

Abstract

Background: Women with disabilities are at risk for poor birth outcomes. Little is known about longer-term health and healthcare utilization of infants of women with disabilities. Objectives: We identified women at risk for disability and evaluated their infants’ emergency department (ED) utilization during the first year of life. Study design: This population-based cohort study used Massachusetts 2007–2009 birth certificates linked to 2007–2010 hospital discharge data. Access Risk Classification System categorized ICD-9 CM/CPT codes into disability risk categories. Infant ED visits were evaluated overall and by severity (emergent/intermediate vs. non-emergent). Cox proportional hazards models provided adjusted estimates. Results were stratified by gestational age (preterm, < 37 weeks, term, 37 + weeks). Results: Of 218,599 women, 6.7% were at risk of disability. Infants born to women at risk had a higher rate of ED visits in their first year than infants born to women not at risk: 0.85 visits/person-year (95% CI 0.84–0.87) vs. 0.55 (0.55–0.55) for term, 0.74 (0.70–0.77) vs. 0.55 (0.54–0.56) for preterm. Utilization varied by maternal diagnosis. Emergent/intermediate and non-emergent visits were both elevated among infants born to women at risk for disability. In adjusted analyses, term infants of women with musculoskeletal diagnoses (HR = 1.3, 95% CI 1.2–1.4) and preterm infants of women with circulatory diagnoses (HR = 1.2, 1.0–1.3) had the highest hazards of ED visit vs. infants of women not at risk of disability. Conclusion: Maternal disability risk is associated with postnatal infant ED utilization; utilization varies by maternal diagnosis. Interventions to improve health of infants born to women with disabilities are warranted.