{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T13:22:16Z","timestamp":1788009736522,"version":"build-2784847793"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi230150-4\"><jats:title>Importance<\/jats:title><jats:p>Postpartum emergency department (ED) visits may indicate poor access to care and risk for maternal morbidity.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230150-5\"><jats:title>Objectives<\/jats:title><jats:p>To identify patient and hospital characteristics associated with postpartum ED visit rates.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230150-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This retrospective cohort study used data from the 2014 to 2016 New York State Inpatient Database and State Emergency Department Database. All obstetric discharges from acute care hospitals in New York State from January 1, 2014, through November 15, 2016, were included. Obstetric discharges in the inpatient database were linked to subsequent ED visits by the same patient in the ED database. Data were analyzed from February 2020 to August 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230150-7\"><jats:title>Exposures<\/jats:title><jats:p>Patient characteristics assessed included age, race, insurance, home zip code income quartile, Charlson Comorbidity Index score, and obstetric risk factors. Hospital characteristics assessed included safety net status, teaching status, and status as a hospital disproportionally serving racial and ethnic minority populations.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230150-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was any ED visit within 42 days of obstetric discharge. Multilevel logistic regression with 2-level nested mixed effects was used to account for patient and hospital characteristics and hospital-level clustering.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230150-9\"><jats:title>Results<\/jats:title><jats:p>Of 608\u202f559 obstetric discharges, 35\u202f299 (5.8%) were associated with an ED visit within 42 days. The median (IQR) birth hospital postpartum ED visit rate was 6.3% (4.6%-8.7%). The mean (SD) age was 28.4 (9.1) years, 53\u202f006 (8.7%) were Asian patients, 90\u202f675 (14.9%) were Black patients, 101\u202f812 (16.7%) were Hispanic patients, and 275\u202f860 (45.3%) were White patients; 292\u202f991 (48%) were insured by Medicaid, and 290\u202f526 (47.7%) had private insurance. Asian patients had the lowest postpartum ED visit rates (2118 ED visits after 53\u202f006 births by Asian patients [3.99%]), and Black patients had the highest postpartum ED visit rates (8306 ED visits after 90\u202f675 births by Black patients [9.15%]). Odds of postpartum ED visits were greater for Black patients (odds ratio [OR],\u20091.31; 95% CI, 1.26-1.35; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and Hispanic patients (OR,\u20091.19; 95% CI, 1.15-1.24; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) relative to White patients; those with Medicare (OR,\u20091.55; 95% CI, 1.39-1.72; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), Medicaid (OR,\u20091.37; 95% CI, 1.34-1.41; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), or self-pay insurance (OR,\u20091.50; 95% CI, 1.41-1.59; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) relative to commercial insurance; births that occurred at safety net hospitals (OR,\u20091.43; 95% CI, 1.37-1.51; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and hospitals disproportionately serving racial and ethnic minority populations (OR,\u20091.14; 95% CI, 1.08-1.20; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001); and births that occurred at hospitals with fewer than 500 births per year (OR,\u20091.25; 95% CI, 1.14-1.39; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) relative to those with more than 2000 annual births. Adjusted odds of postpartum ED visits were lower after birth at teaching hospitals (OR, \u20090.82; 95% CI, 0.74-0.91; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and metropolitan hospitals (OR, 0.74; 95% CI, 0.65-0.85; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230150-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This cohort study found that Black and Hispanic patients experienced higher adjusted odds of postpartum ED visits across all hospital types, particularly at safety net hospitals and those disproportionately serving racial and ethnic minority populations . These findings support the urgent need to mitigate structural racism underlying maternal health disparities.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.3927","type":"journal-article","created":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T15:01:58Z","timestamp":1679410918000},"page":"e233927","source":"Crossref","is-referenced-by-count":10,"title":["Patient Sociodemographics and Comorbidities and Birth Hospital Characteristics Associated With Postpartum Emergency Department Care"],"prefix":"10.1001","volume":"6","author":[{"given":"Haley","family":"Zarrin","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Vargas-Torres","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New 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