Financial Toxicity, Racial Disparities, and Healthcare Access in Pregnant Women with Insomnia

Document Type

Conference Proceeding

Publication Date

5-1-2025

Publication Title

Sleep

Abstract

Introduction: Insomnia affects half of women during pregnancy, which reduces quality of life and harms maternal health. As awareness of prenatal insomnia increases, more pregnant women are seeking help for their sleep. However, little is known about real-world barriers pregnant women face when seeking insomnia treatment. The present study explored associations of race and financial toxicity with clinical morbidity and care access among pregnant women seeking insomnia care. Methods: Three-hundred-and-ninety-three pregnant women (Age: 30.7 ± 4.9yrs, Gestation: 25.7 ± 3.4wks) seeking treatment for insomnia in a large health system completed an online survey. Outcomes included sociodemographics, the Comprehensive Score of financial Toxicity survey, Edinburgh Postnatal Depression Scale, and Perinatal Rumination Scale-Night. We employed chi-square analyses and multivariate linear and logistic regression. Results: Half of treatment-seeking patients identified racially as white (52.7%), whereas 21.7% identified as Black (most well-represented groups). Nearly half of the sample reported no/mild financial toxicity, whereas 39.2% endorsed moderate financial toxicity and 13.9% endorsed severe financial toxicity. Regarding health insurance, 29.9% of patients had public insurance. Relative to white patients, non-white patients reported higher levels of moderate-to-severe financial toxicity (62.4% vs 45.0%) and greater utilization of public insurance (40.9% vs 20.1%). Multivariate regression showed that financial toxicity was independently associated with depression (b=-.252, p<.001), perinatal rumination (b=-.491, p<.001), and suicidal ideation (SI, OR=1.07, p<.001), whereas race was not. Indeed, more severe financial toxicity was associated with greater disease burden as indicated by higher rates of comorbid depression (Severe toxicity: 80.0%, Moderate: 61.9%, No/Mild: 29.7%), perinatal rumination (Severe: 80.0%, Moderate: 56.8%, No/Mild: 28.1%), and SI (Severe: 23.6%, Moderate: 16.8%, No/Mild: 5.4%). Unfortunately, patients with greater financial toxicity were less likely to be able to afford copays for psychotherapy services (Severe toxicity: 69.1% cannot afford copays, Moderate: 57.1%, No/Mild: 27.2%). Conclusion: Pregnant women seeking insomnia treatment present with high rates of depression, perinatal rumination, and SI. Non-white women are over-represented among those with moderate-to-severe financial toxicity, and greater financial toxicity is associated with greater clinical morbidity. Despite this greater disease burden, patients with greater financial toxicity are disproportionately unable to afford care, thereby severely limiting treatment access for those with highest need.

Volume

48

Issue

Supplement 1

First Page

A260

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