Title

National ED Utilization and Admission for Hypertensive Disorders in Pregnancy and Postpartum, (2006-2019)

Document Type

Conference Proceeding

Publication Date

3-2023

Publication Title

Reproductive Sciences

Abstract

Introduction: Hypertensive disorders in pregnancy and the postpartum period (HDPP)-chronic hypertension, gestational hypertension, preeclampsia, and eclampsia-are leading causes of maternal mortality in the United States. Despite national standards for prenatal and postpartum care, the emergency department (ED) remains a critical access point for pregnant and postpartum patients. Previous findings have demonstrated increased ED visits for HDPP, yet little is known about the national trend of ED utilization with subsequent admission for HDPP. Our objective was to examine ED utilization and admission for HDPP between 2006-2019 and to identify risk factors for admission.

Methods: We conducted a retrospective study using data extracted from the Nationwide Emergency Department Sample (NEDS), developed by the Healthcare Cost and Utilization Project. ICD-9 and ICD-10 codes were used to identify women aged 15-50 who were seen in the ED with a primary diagnosis of pregnancy-related hypertension between 2006-2019. Variables of interest included rac, income quartile, insurance type, and admission. Data on rac was available for 2019 only. Chi square-test, T-test and linear/logistic regression analysis were performed using SAS 9.4.

Results: From 2006 to 2019, there were 600,818 ED visits with primary diagnosis of HDPP (0.11% of all visits). The admission rate for HDPP was 60.0% compared to 7.4% for all other primary diagnoses. ED visits for HDPP were highest among patients with Medicaid insurance (54.2%), living in metropolitan areas (69.2%), and presenting to teaching hospitals (69%) (p<0.01). Admission for HDPP significantly increased from 54.8% to 77.3% during the study period (p <0.01). Patients with Medicaid insurance were twice as likely to be admitted compared to self-pay (p<0.0001). Admissions were 78% higher for younger patients (aged 15-19) compared to older patients (age 45-50) (p<0.01). White patients experienced increasing hospital admission with increasing income quartile (30.6% lowest income quartile to 59.3% highest income quartile, p<0.01), while Black patients experienced higher admission as income quartile decreased (42.7% lowest income quartile to 14.5% highest income quartile, p<0.01).

Conclusion: The rate of ED visits and admission for HDPP increased significantly between 2006 and 2019. Younger age (15-19) and having Medicaid insurance were associated with higher ED utilization and admission. These findings highlight the need for increased outpatient hypertension monitoring programs particularly for our youngest patients and those with public insurance. More studies are needed to better understand the intersectional impact of rac and income quartile given the inverse impacts on admission rates.

Issue

30

First Page

246A

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