Medical Student Eastern Virginia Medical School Norfolk, Virginia, United States
Background: The postpartum period (PP) is a critical time to address physical and mental health conditions. Understanding barriers to PP visit attendance, particularly for women of color, is especially important for understanding disparities in maternal morbidity and mortality and for efforts toward achieving equitable care. Objective: To identify trends in PP attendance looking at various maternal characteristics such as age, race, ethnicity, insurance type, and onset of prenatal care. Design/Methods: We surveyed 100 birthing people who brought their infants in for their 2-6 month well child checks at a single academic center. Standardized information about insurance, prenatal care, and attendance at postpartum visits was collected. Surveys were analyzed using Mann Whitney, Chi-square, and multivariable regression analyses. Results: Of 100 people, 74 attended their PP visit. There was no significant difference for appointment attendance in terms of age (p=0.47), race (p=0.67), or ethnicity (p=0.63) (Table 1). There was a significant trend towards decreased attendance based on insurance type: private (100%) to public (75%), military (66%) and uninsured (50%) (p=0.048) (Figure 1), but individual group sizes were very small. Those who started prenatal care in the 2nd or 3rd trimester were less likely to attend a PP visit (p=0.057) compared to those who had their initial prenatal visit in the 1st trimester, but the regression analysis did not reach statistical significance. There was a significant association with Social Deprivation Index (SDI) scores and non-attendance in both univariate (p=0.02) and multivariate analyses (p=0.03). Receiver operating characteristics curves of two models (Figure 2), including race and ethnicity vs. SDI and insurance type showed racial demographics had significantly lower (p=0.02) predictive capabilities (AUC 0.53) compared to SDI and insurance type (AUC 0.73).
Conclusion(s): This data shows that patients from higher SDI neighborhoods were significantly less likely to attend their appointment. PP visit attendance was strongly influenced by SES factors (i.e., insurance, SDI) than racial factors, although SDI may be infrastructurally influenced by these factors. This was seen in our data on Hispanic mothers, who, in the Hampton Roads area, are more densely populated in high SDI neighborhoods. Allocation of resources to areas with high SDIs may improve visit adherence and potentially outcomes.
.jpg "Asma M. Azam, BS (she/her/hers) photo")