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Socioeconomic Disparities in Ectopic Pregnancy: Predictors of Adverse Outcomes from Illinois Hospital-Based Care, 2000–2006

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Abstract

This study aimed to identify the incidence of adverse outcomes from ectopic pregnancy hospital care in Illinois (2000–2006), and assess patient, neighborhood, hospital and time factors associated with these outcomes. Discharge data from Illinois hospitals were retrospectively analyzed and ectopic pregnancies were identified using DRG and ICD-9 diagnosis codes. The primary outcome was any complication identified by ICD-9 procedure codes. Secondary outcomes were length of stay and discharge status. Residential zip codes were linked to 2000 U.S. Census data to identify patients’ neighborhood demographics. Logistic regression was used to identify risk factors for adverse outcomes. Independent variables were insurance status, age, co-morbidities, neighborhood demographics, hospital type, hospital ectopic pregnancy service volume, and year of discharge. Of 13,007 ectopic pregnancy hospitalizations, 7.4% involved at least one complication identified by procedure codes. Hospitalizations covered by Medicare (for women with chronic disabilities) were more likely than those with other source or without insurance to result in surgical sterilization (OR 4.7, P = 0.012). Hospitalization longer than 2 days was more likely with Medicaid (OR 1.46, P < 0.0005) or no insurance (OR 1.35, P < 0.0005) versus other payers, and among church-operated versus secular hospitals (OR 1.21, P < 0.0005). Compared to public hospitals, private hospitals had lower rates of complications (OR 0.39, P < 0.0005) and of hospitalization longer than 2 days (OR 0.57, P < 0.0005). With time, hospitalizations became shorter (OR 0.53, P < 0.0005) and complication rates higher (OR 1.33, P = 0.024). Ectopic pregnancy patients with Medicaid, Medicare or no insurance, and those admitted to public or religious hospitals, were more likely to experience adverse outcomes.

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Acknowledgments

This study was supported by a grant from the Chicago Center of Excellence in Health Promotions Economics. The funder had no involvement in study design, data collection or analysis, or manuscript preparation. The authors thank Kathleen Rowland, MD, for serving as independent data coder, Peter Burkiewicz for technical assistance with the dataset, and Irma Hasham for general research assistance.

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Authors and Affiliations

  1. Department of Family Medicine, The University of Chicago, Chicago, IL, USA

    Debra B. Stulberg

  2. Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA

    Debra B. Stulberg & Stacy Tessler Lindau

  3. MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA

    Debra B. Stulberg & Stacy Tessler Lindau

  4. Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA

    James X. Zhang

  5. Department of Medicine, The University of Chicago, Chicago, IL, USA

    Stacy Tessler Lindau

  6. 5841 South Maryland Avenue, MC 7110, Room M-156, Chicago, IL, 60637, USA

    Debra B. Stulberg

  7. Department of Healthcare Policy and Research, Virginia Commonwealth University, 209E McGuire Hall, PO Box 980533, Richmond, VA, 23298, USA

    James X. Zhang

  8. 5841 South Maryland Avenue, MC 2050, Chicago, IL, 60637, USA

    Stacy Tessler Lindau

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  1. Debra B. Stulberg
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Correspondence to Debra B. Stulberg.

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Stulberg, D.B., Zhang, J.X. & Lindau, S.T. Socioeconomic Disparities in Ectopic Pregnancy: Predictors of Adverse Outcomes from Illinois Hospital-Based Care, 2000–2006. Matern Child Health J 15, 234–241 (2011). https://doi.org/10.1007/s10995-010-0579-6

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  • DOI: https://doi.org/10.1007/s10995-010-0579-6

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