Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression

Avis L. Chan, Nan Guo, Rita Popat, Thalia Robakis, Yair Y. Blumenfeld, Elliott Main, Karen A. Scott, Alexander J. Butwick

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Objective: To estimate racial and ethnic differences in rates of hospital-based care associated with postpartum depression. Methods: This is a retrospective cohort study using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes within data from the Office of Statewide Planning and Development in California. We included primiparous women who underwent delivery hospitalization from 2008 to 2012. The primary outcome was the first postpartum hospital encounter with a ICD-9-CM code for depression over a 9-month period after delivery. We examined the cumulative incidence of hospital-based care for postpartum depression by race/ethnicity. Logistic regression was used to estimate relative risk. Results: The study cohort consisted of 984,167 primiparous women: 314,037 (32%) were non-Hispanic White; 59,754 (6%) were non-Hispanic Black; 150,855 (15%) were non-Hispanic Asian; 448,770 (46%) were Hispanic; and 10,399 (1%) were other races. The cumulative incidence of hospital-based care for postpartum depression was highest for Black women (39; 95% CI = 34–44 per 10,000 deliveries) and lowest for Asian women (7; 95% CI = 5–8 per 10,000 deliveries). Compared with White women, hospital-based care for postpartum depression was more likely to be provided to Black women (OR = 2.3; 95% CI = 1.9–2.7), whereas care was less likely for Asians (OR = 0.4; 95% CI = 0.3–0.5) and Hispanics (OR = 0.8; 95% CI = 0.7–1.0). Similar findings were observed after excluding women with antepartum depression, adjusting for sociodemographic and clinical variables, and stratifying according to care settings. Conclusion: Compared with White women, hospital-based care for postpartum depression more frequently impacts Black women. Identifying and improving inequities in access to and utilization of mental health care for postpartum women should be a maternal health priority.

Original languageEnglish
Pages (from-to)220-229
Number of pages10
JournalJournal of racial and ethnic health disparities
Volume8
Issue number1
DOIs
StatePublished - Feb 2021

Keywords

  • Health disparities
  • Hospital care
  • Mental health care
  • Postpartum depression
  • Race and ethnicity

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