Disparities In Covid-19 Incidence And Outcomes By Insurance Type

Recent studies suggest that racial and ethnic minorities are disproportionately affected by COVID-19. How insurance status impacts these disparate outcomes is not understood. The goal of this study is to describe differences in COVID-19 incidence and outcomes by insurance type among pregnant women delivering during the COVID-19 pandemic. This is a retrospective cohort analysis of women delivering at a tertiary care center in New York. Subjects were universally tested for SARS-CoV-2 by nasopharyngeal PCR swab upon admission from March-August 2020. Insurance was classified as private or Medicaid; patients with other forms of insurance were excluded. The primary outcome was SARS-CoV-2 infection rate. Secondary outcomes included severity of disease and perinatal outcomes. These were compared using Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables. Logistic regression models adjusting for demographic and clinical factors were fit for each outcome with measures of association described as odds ratios (OR) with 95% confidence intervals (CI). 1845 deliveries met inclusion criteria. 971 (52.6%) had private insurance and 874 (47.4%) had Medicaid. SARS-CoV-2 was detected in 241 (13.1%) of patients presenting for delivery. Patients with Medicaid were significantly more likely to be infected with SARS-CoV-2 than those with private insurance (19.1% vs 7.6%, p<0.0001). No difference was detected in severity of disease, necessity of hospitalization for SARS-CoV-2 illness, diagnosis of pneumonia, or delivery complications including chorioamnionitis, preterm delivery, and 5 minute Apgar <7 (Table 1). The increased risk of SARS-CoV-2 infection among patients with Medicaid persisted after controlling for confounding variables (OR 1.72, 95% CI: 1.10, 2.69) (Table 2). Women with Medicaid were at significantly higher risk of SARS-CoV-2 infection, but insurance type was not predictive of disease severity or outcomes. This study highlights the need to focus public health efforts on reducing the spread in communities most at risk for infection.View Large Image Figure ViewerDownload Hi-res image Download (PPT)