Emergency department utilization during the first year of life among infants born to women at risk of disability.
Karen M Clements, Jianying Zhang, Linda M Long-Bellil and 1 others
PMID 31431409WHAT IT FOUND
Infants of mothers flagged by claims data as at risk for disability had more first-year ED visits, especially when the mother had mental illness or both mental and physical diagnoses.
Key findings
01Infants of mothers classified at risk for disability had 0.83 ED visits per person-year in the first year, compared with 0.55 among infants of mothers not classified at risk.
02Among infants of at-risk mothers, ED visit rates were highest for co-occurring mental and physical diagnoses (1.08 visits per person-year) and mental illness alone (1.00 visits per person-year).
03In fully adjusted analyses, term infants of mothers with musculoskeletal diagnoses had a reported hazard ratio of 1.29 for at least one ED visit, and term infants of mothers with nervous system/sense organ diagnoses had a reported hazard ratio of 1.20.
STILL TO COME
How it was doneWhat they found
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What it does not show
The disability exposure was a claims-based risk flag, not a direct measure of functional limitation, and many women flagged as at risk may not have had self-reported disability. The algorithm was not validated among women of childbearing age, and some diagnoses such as hypertension may not limit function in this group. Only diagnoses recorded around delivery were captured, and pharmacy claims were unavailable, so some conditions may have been missed or misclassified. The analysis did not measure usual source of care, infant disability or health status, or other reasons families might use the ED. The study covered one state and a fixed birth cohort, so results may not apply elsewhere or later.
Declared interests
The supplied article metadata lists NIH extramural research support. No author conflicts of interest or funding statement is included.
The easy way to misread this
Do not read this as evidence that maternal disability causes more infant ED visits. The study only shows an association using claims-based disability risk, and that method misclassified many women as at risk.