Health insurance type associated with differences in infant mortality rates in the US

1. In this cohort study, patients with Medicaid insurance coverage had higher rates of infant mortality compared to those with private insurance.

Evidence rating level: 2 (Good)

The infant mortality rate (IMR) in the United States is one of the highest among developed countries. Researchers aimed to determine whether access to private health insurance compared to Medicaid insurance has an impact on the IMR. Medicaid Insurance is available to those with a gross family income within 138% of the federal poverty level. Data were collected from the Centers for Disease Control and Prevention birth and infant death records database, 2017 to 2020. Infants were excluded from the study if they were born with congenital anomalies, born outside of 20 to 42 weeks of gestational age, or if their mothers had self-pay insurance status. Of 13,562,526 hospital-born infants in the study, 54% were covered with private insurance, and 46% were covered with Medicaid. Researchers adjusted for several confounding variables including race, infant sex, multiple gestations, several maternal pregnancy risk factors, education level, and tobacco use. The IMR was lower for those with private insurance compared to Medicaid insurance, (2.75 vs 5.30 deaths per 1000 live births; adjusted relative risk [aRR], 0.81; 95% CI, 0.69-0.95; P = .009). The post-neonatal mortality rate was similarly lower for those with private insurance compared to Medicaid insurance, (0.81 vs 2.41 deaths per 1000 births; aRR, 0.57; 95% CI, 0.47-0.68; P < .001). Additionally, private insurance was associated with a significantly reduced risk of low birth weight infants, breech delivery, and preterm birth, and significantly greater use of prenatal care in early pregnancy. A limitation of this study is that additional confounding variables were not adjusted for, particularly prenatal alcohol and recreational drug use. It is also important to consider that insurance status is directly related to socioeconomic status, and therefore cannot be treated as a true independent variable. Overall, this study demonstrates that those giving birth in the United States with Medicaid insurance coverage have higher rates of infant mortality compared to those with private coverage. Future work may examine whether there are opportunities to improve prenatal, intrapartum, and postnatal care for those in the US with Medicaid coverage.

Click to read the study in JAMA Network Open

Image: PD

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