Characteristics of Patients Who Attend the 7- to 10-Day Postpartum Visit for Blood Pressure Evaluation

2021 ◽  
Author(s):  
Maggie Tallmadge ◽  
Mary Christine Livergood ◽  
Alina Tvina ◽  
Sarah Evans ◽  
Jennifer McIntosh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Race And Ethnicity ◽  
Private Insurance ◽  
Chronic Hypertension ◽  
Postpartum Visit ◽  
Public Insurance ◽  
Maternal Characteristics ◽  
Lower Odds ◽  
Black Race ◽  
Cesarean Birth

Objective To assess maternal characteristics that predict attendance of postpartum blood pressure evaluation in patients with hypertensive disorders of pregnancy (HDP). Study Design A retrospective case–control study of patients with HDP delivering at a single academic institution (2014–2018). Diagnosis of HDP included gestational hypertension, chronic hypertension, preeclampsia, and superimposed preeclampsia. Univariable and multivariable analyses were used to determine maternal characteristics independently associated with attendance of the 7- to 10-day postpartum blood pressure evaluation. Results Of the 1,041 patients included in the analysis, 603 (57.9%) attended the 7- to 10-day postpartum blood pressure check. Maternal sociodemographic, clinical, and obstetric factors differed significantly between patients who attended the postpartum blood pressure visit and those who did not. In univariable analyses, nulliparity, non-Hispanic black race and ethnicity, public insurance, HDP with severe features, cesarean birth, gestational age at delivery, receipt of magnesium, mild-range blood pressures on day of discharge, and initiation of antihypertensive medication were associated with attendance of the 7- to 10-day postpartum visit. In multivariable analysis, factors significantly associated with higher odds of attending the blood pressure visit were nulliparity (adjusted odds ratio [aOR]: 1.58; 95% confidence interval: [CI]: 1.14–2.17), severe HDP (aOR: 1.94, 95% CI: 1.44–2.61), and cesarean birth (aOR: 1.92, 95% CI: 1.43–2.59). In contrast, factors associated with lower odds of attendance were non-Hispanic black race and ethnicity compared with non-Hispanic white (aOR: 0.68, 95% CI: 0.47–0.97), and public insurance (aOR: 0.65, 95% CI: 0.45–0.93) compared with private insurance. Conclusion Clinical factors such as nulliparity, severe HDP, and cesarean birth were associated with higher rates of postpartum blood pressure evaluation attendance, whereas sociodemographic factors such as maternal non-Hispanic black race and ethnicity and public insurance were associated with lower odds of postpartum blood pressure check attendance. Key Points

Abstract 16833: Trends in Primary Payer Status and Association With Outcomes in Pediatric Heart Transplantation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kathryn Restaino ◽  
Xuemei Zhang ◽  
Kimberly Y Lin ◽  
Joseph Rossano ◽  
Danielle Burstein ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Private Insurance ◽  
Long Term Outcomes ◽  
Public Insurance ◽  
Black Race ◽  
Pediatric Heart Transplantation ◽  
Primary Payer ◽  
The Impact

Background: Pediatric heart transplantation (HT) is resource-intensive. Adult studies have shown an increase in the proportion of adult HT funded by public insurance with outcomes inferior to those with private coverage. Trends in the funding of pediatric HT and associations with outcomes in children have not been described. Methods: We queried the United Network for Organ Sharing (UNOS) database for patients less than 18 years of age, listed for and undergoing HT from 1994 to 2018. We identified primary payer at listing (TCR), transplant (TRR), 1 year follow up, and between 1-5 years following HT. Trends in primary payer were analyzed using generalized logit regression. Cox regression was used to evaluate the impact of insurance on survival. Results: An increase in the proportion of patients with public insurance at the time of HT was observed. Forty eight percent of HT patients in 1994 and 59% in 2018 were publicly insured (P<0.0001). Eight percent of patients changed from private to public insurance between TCR and TRR, and 15% transitioned from private to public from TRR to 1 year post-HT. Of those who changed insurance at one year follow up, 57% transitioned from private to public insurance. For patients undergoing HT, unadjusted long-term survival was worse for patients with public insurance (P <0.0001). When adjusted for age and region, black race (HR 1.57, P <0.001) and age 13-17y (HR 1.44, P<0.0001) were independently associated with mortality. When evaluating outcomes based on change of insurance and adjusting for age and region, age 13-17y (ref <1y, HR 2.3 P <0.0001), white race (ref. black race, HR 0.54, P <0.0001), continuous public insurance (ref continuous private insurance, HR 1.49, P <0.0001), and transition to public insurance (ref continuous private insurance, HR 1.37, P<0.007) were associated with increased mortality. Conclusion: There has been a statistically significant trend towards increasing public insurance for patients awaiting, at the time of, and after HT. Patients that maintain or transition to public insurance following transplant have worse long term outcomes. As the number of patients undergoing HT with public insurance funding continues to increase, understanding of how insurance status impacts long-term outcomes is important.

scholarly journals Postnatal assessment for renal dysfunction in women with hypertensive disorders of pregnancy

2021 ◽  
Author(s):  
Emmanouil Kountouris ◽  
Katherine Clark ◽  
Polly Kay ◽  
Nadia Roberts ◽  
Kate Bramham ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Gestational Hypertension ◽  
Chronic Hypertension ◽  
Hypertensive Disorder ◽  
Hypertensive Disorders Of Pregnancy ◽  
Postpartum Visit ◽  
Protein Excretion ◽  
Hypertensive Disorders

Abstract Background Hypertensive disorders of pregnancy are associated with chronic kidney disease. Early detection of renal dysfunction enables implementation of strategies to prevent progression. International guidelines recommend review at 6–8 weeks postpartum to identify persistent hypertension and abnormal renal function, but evidence for the efficacy of this review is limited. Methods All women attending a specialist fetal-maternal medicine clinic for hypertensive disorders of pregnancy (pre-eclampsia, chronic hypertension, gestational hypertension) were invited for a 6–8 weeks postpartum review of their blood pressure and renal function in order to establish the prevalence and independent predictors of renal dysfunction. Renal dysfunction was defined as low estimated Glomerular Filtration Rate (eGFR < 60 ml/min/1.73 m2) or proteinuria (24-h protein excretion > 150 mg or urinary albumin-to-creatinine ratio > 3 mg/mmol). All women attending a specialist clinic for hypertensive disorders were invited for a 6–8 weeks postpartum review of their blood pressure and renal function. Demographics, pregnancy and renal outcomes were prospectively collected. Results Between 2013 and 2019, 740 of 1050 (70.4%) women who had a pregnancy complicated by a hypertensive disorder attended their 6–8 weeks postpartum visit. Renal dysfunction was present in 32% of the total cohort and in 46% and 22% of women with and without pre-eclampsia, respectively. Multivariate logistic regression demonstrated that independent predictors were pre-eclampsia, chronic hypertension, highest measured antenatal serum creatinine, highest measured antenatal 24-h urinary protein, and blood pressure ≥ 140/90 mmHg at the postnatal visit. Conclusions Renal dysfunction was present in one in three women with hypertensive disorders of pregnancy at 6–8 weeks postpartum. This includes women with gestational hypertension and chronic hypertension without superimposed pre-eclampsia, and thus these women should also be offered postnatal review. Graphic abstract

Social versus Private Insurance

2018 ◽  
Author(s):  
Pierre Pestieau ◽  
Mathieu Lefebvre
Keyword(s):  
Social Insurance ◽  
Private Insurance ◽  
Population Ageing ◽  
Fiscal Competition ◽  
Public Insurance ◽  
The Public ◽  
Social Risks ◽  
The Family ◽  
Private And Public

This chapter looks at the role of the public versus the private sector in the provision of insurance against social risks. After having discussed the evolution of the role of the family as support in the first place, the specificity of social insurance is emphasized in opposition to private insurance. Figures show the extent of spending on both private and public insurance and the chapter presents economic reasons to why the latter is more developed than the former. Issues related to moral hazard and adverse selection are addressed. The chapter also discusses somewhat more general arguments supporting social insurance such as population ageing, unemployment, fiscal competition and social dumping.

Does genetically-defined ancestry predict booking blood pressure in pregnant women with chronic hypertension?

2019 ◽  
Vol 17 ◽  
pp. S11
Author(s):  
Frances Conti-Ramsden ◽  
Raquel Iniesta ◽  
Phil Chowienczyk ◽  
Lucy C. Chappell
Keyword(s):  
Blood Pressure ◽  
Pregnant Women ◽  
Chronic Hypertension

844 Characteristics of patients that attend 7-10 days postpartum visit for blood pressure check

2021 ◽  
Vol 224 (2) ◽  
pp. S524-S525
Author(s):  
Maggie Tallmadge ◽  
Mary Christine Livergood ◽  
Alina Tvina ◽  
Sarah Evans ◽  
Jennifer McIntosh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Postpartum Visit

Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement

2021 ◽  
pp. 000348942110157
Author(s):  
Jennifer L. McCoy ◽  
Ronak Dixit ◽  
R. Jun Lin ◽  
Michael A. Belsky ◽  
Amber D. Shaffer ◽  
...  
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Private Insurance ◽  
Chronic Otitis Media ◽  
The United States ◽  
Socioeconomic Disparities ◽  
Tube Placement ◽  
Median Income ◽  
Public Insurance ◽  
Tympanostomy Tubes

Objectives: Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). Methods: A retrospective cohort study was performed at a tertiary children’s hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. Results: A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance ( P < .001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P = .003). Conclusions: Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. Level of Evidence: 4

scholarly journals Human Milk Oligosaccharide Profile Variation Throughout Postpartum in Healthy Women in a Brazilian Cohort

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 790 ◽  
Author(s):  
Ana Lorena Ferreira ◽  
Ronaldo Alves ◽  
Amanda Figueiredo ◽  
Nadya Alves-Santos ◽  
Nathalia Freitas-Costa ◽  
...  
Keyword(s):  
Human Milk ◽  
Rank Correlation ◽  
Postpartum Visit ◽  
Maternal Characteristics ◽  
Milk Oligosaccharide ◽  
Healthy Women ◽  
Human Milk Oligosaccharide ◽  
Post Hoc ◽  
Brazilian Cohort ◽  
Non Negative Matrix Factorization

Human milk oligosaccharide (HMO) composition varies throughout lactation and can be influenced by maternal characteristics. This study describes HMO variation up to three months postpartum and explores the influences of maternal sociodemographic and anthropometric characteristics in a Brazilian prospective cohort. We followed 101 subjects from 28–35 gestational weeks (baseline) and throughout lactation at 2–8 (visit 1), 28–50 (visit 2) and 88–119 days postpartum (visit 3). Milk samples were collected at visits 1, 2 and 3, and 19 HMOs were quantified usinghigh-performance liquid chromatography with fluorescence detection (HPLC-FL). Friedman post-hoc test, Spearman rank correlation for maternal characteristics and HMOs and non-negative matrix factorization (NMF) were used to define the HMO profile. Most women were secretors (89.1%) and presented high proportion of 2′-fucosyllactose (2′FL) at all three sample times, while lacto-N-tetraose (LNT, 2–8 days) and lacto-N-fucopentaose II (LNFPII, 28–50 and 88–119 days) were the most abundant HMOs in non-secretor women. Over the course of lactation, total HMO weight concentrations (g/L) decreased, but total HMO molar concentrations (mmol/L) increased, highlighting differential changes in HMO composition over time. In addition, maternal pre-pregnancy body mass index (BMI) and parity influence the HMO composition in healthy women in this Brazilian cohort.

Health Insurance Differentials Among Minority Children With Chronic Conditions and the Role of Federal Agencies and Private Foundations in Improving Financial Access

PEDIATRICS ◽  
1993 ◽  
Vol 91 (5) ◽  
pp. 1040-1047
Author(s):  
Margaret A. McManus ◽  
Paul Newacheck
Keyword(s):  
Health Insurance ◽  
Race And Ethnicity ◽  
Health Care Policy ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Minority Population ◽  
Hispanic Children ◽  
Health Services Use ◽  
Financial Barriers ◽  
White Children

Minorities experience a disproportionate share of the financial barriers resulting from higher rates of uninsuredness and a greater reliance on Medicaid vs private insurance. As a result, health services use and patterns of expenditures vary markedly by race and ethnicity.1,2 National survey data reveal a rapid increase in the number of uninsured black and Hispanic persons between 1977 and 1987.3 The major factors contributing to this increase are (1) overall growth in the size of the minority population, especially Hispanics; (2) reductions in private insurance coverage; and (3) the lack of significant expansions in public programs, largely Medicaid (note: several Medicaid eligibility expansions affecting poor children occurred during and after 1987). In 1987, 14% of white children younger than age 18 were uninsured compared to 22% of black children and 33% of Hispanic children (Cornelius LJ. Unpublished data). Black and Hispanic persons were more likely to rely on Medicaid as their primary financing source than were white persons.3 In 1987, 8% of white children were covered by Medicaid vs 38% of black and 28% of Hispanic children (Cornelius LJ. Unpublished data from the Agency for Health Care Policy and Research, 1992.). Despite Medicaid's importance as a financing source, low reimbursement rates have resulted in inadequate provider participation and corresponding access barriers.4,5 In comparison with white persons, minorities have less access to employer-based insurance benefits. Part of the reason lies in the types of jobs that are disproportionately held by minorities. Personal service and agricultural employers typically do not offer health insurance to their employees.

Abstract W P250: The Impact of Acute Hypertensive Response on Mortality After Intracerebral Hemorrhage Differs Among Patients With and Without Left Ventricle Hypertrophy

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Octavio M Pontes-Neto ◽  
Sergi Martinez-Ramirez ◽  
Anand Viswanathan ◽  
Timothy C Tan ◽  
Maria C Nunes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricle ◽  
Acute Phase ◽  
Blood Pressure Reduction ◽  
Chronic Hypertension ◽  
Pressure Reduction ◽  
Left Ventricle Hypertrophy ◽  
Ventricle Hypertrophy ◽  
Haenszel Test ◽  
Intensive Blood Pressure

Background: While acute hypertensive response (AHR) predicts worse outcome in intracerebral hemorrhage (ICH), the INTERACT-2 trial recently failed to definitively demonstrate a major benefit of intensive blood pressure reduction on these patients. A possible explanation is that the detrimental effect of AHR on outcome may differ among ICH patients with and without previous chronic hypertension. Objective: to explore whether the prognosis of patients with AHR during the acute phase of ICH differs according to the presence or absence of left ventricle hypertrophy (LVH), which is a marker of chronic hypertensive organ damage. Method: we performed a retrospective analysis of a prospective cohort of patients with primary ICH presenting to an academic hospital between January/2000 and December/2012 with age > 18 years, who had a transthoracic echocardiogram available. LVH was defined according to Penn convention. AHR was defined as systolic blood pressure > 180 mmHg on admission. Mantel-Haenszel test was initially used to assess if LVH status influenced the effect of AHR on mortality. For subsequent analyses, ICH patients were divided in 3 groups: without AHR (reference); AHR without LVH; AHR with LVH. A multivariate logistic regression model was then used to identify independent predictors of mortality at 30-days. Results: 430 patients met inclusion criteria. AHR was present in 196 (46.6%), LVH was present in 233 (54.2%); 30-day mortality was 15.6%. On Mantel-Haenszel test, we found a trend (p=0.09) suggesting that absence of LVH increased AHR effect on mortality (OR:1.64; 95% CI: 0.95-2.8; p=0.07). On multivariate analysis, patients with AHR without LVH had significantly higher mortality (OR: 2.65; 95%CI: 1.15 to 6.1; p=0.022) when compared to patients without AHR, after adjusting for baseline characteristics. There was only a trend towards increased mortality in the group of patients with AHR and LVH (OR:2.22; 95% CI: 0.99-5.0; p=0.053). Conclusions: Patients without chronic hypertension appear to be more susceptible to the detrimental effects of AHR during the acute phase of ICH. Stratification of patients with ICH may help to identify those that will have greater benefit with intensive blood pressure reduction in the acute phase of ICH.

Abstract P076: Increased Burden Of Chronic Illness Among Insured Compared To Uninsured Sudden Death Victims

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Reaves Houston ◽  
Susan Keen ◽  
Chelsea Deitelzweig ◽  
Hannah Jones ◽  
Sarah Laible ◽  
...  
Keyword(s):  
Health Insurance ◽  
Chronic Illness ◽  
Sudden Death ◽  
Private Insurance ◽  
Chronic Illnesses ◽  
Categorical Variables ◽  
Insurance Status ◽  
Public Insurance ◽  
Status Data ◽  
Lower Frequencies

Introduction: Lack of health insurance is associated with reduced access to medical care and increased mortality. Chronic illness is associated with sudden death, a major cause of natural death. Insurance status of sudden death victims has not been characterized. Hypothesis: Uninsured compared to insured sudden death victims will have more chronic illnesses. Methods: From 2013-2015, emergency medical services-attended out of hospital deaths among ages 18-64 in Wake County, NC were screened to adjudicate sudden deaths. Medical records were reviewed for demographic, clinical, and health insurance status data. Insurance status was characterized as private, public, or no insurance. Cases were excluded from the analysis if no information on insurance was available. Comparisons of demographic and clinical characteristics were made between the three insurance status groups using Student’s t-test and ANOVA for continuous and categorical variables, respectively. Results: Of 399 cases of sudden death, insurance status data was available for 130: 25 (19.2%) had no insurance, 62 (47.7%) had public insurance, 31 (23.8%) had private insurance, and 12 (9.2%) had insurance of unknown type. Uninsured victims had lower frequencies of hypertension, hyperlipidemia, and chronic respiratory disease than those with private or public insurance, and lower frequencies of diabetes mellitus, mental illness, and substance abuse than those publicly insured (Table 1). No significant differences were found in coronary artery disease, age, gender, race, marital status, or years of education. Conclusion: Uninsured sudden death victims have less chronic illnesses than those insured. This counterintuitive finding suggests that uninsured sudden death victims have undiagnosed chronic illnesses that are treatable and preventable and contribute to their death. Our results suggest that expanding health insurance among working age adults may reduce the incidence of sudden death.

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