Background
While there is a growing interest in addressing social determinants of health in clinical
settings, there are limited data on the relationship between unstable housing and
both obstetric outcomes and health care utilization.
Objective
The objective of the study was to investigate the relationship between unstable housing,
obstetric outcomes, and health care utilization after birth.
Study Design
This was a retrospective cohort study. Data were drawn from a database of liveborn
neonates linked to their mothers’ hospital discharge records (2007–2012) maintained
by the California Office of Statewide Health Planning and Development. The analytic
sample included singleton pregnancies with both maternal and infant data available,
restricted to births between the gestational age of 20 and 44 weeks, who presented
at a hospital that documented at least 1 woman as having unstable housing using the
International Classification of Diseases, ninth edition, codes (n = 2,898,035). Infants with chromosomal abnormalities and
major birth defects were excluded. Women with unstable housing (lack of housing or
inadequate housing) were identified using International Classification of Diseases, ninth edition, codes from clinical records. Outcomes of interest included preterm
birth (<37 weeks’ gestational age), early term birth (37–38 weeks gestational age),
preterm labor, preeclampsia, chorioamnionitis, small for gestational age, long birth
hospitalization length of stay after delivery (vaginal birth, >2 days; cesarean delivery,
>4 days), emergency department visit within 3 months and 1 year after delivery, and
readmission within 3 months and 1 year after delivery. We used exact propensity score
matching without replacement to select a reference population to compare with the
sample of women with unstable housing using a one-to-one ratio, matching for maternal
age, race/ethnicity, parity, prior preterm birth, body mass index, tobacco use during
pregnancy, drug/alcohol abuse during pregnancy, hypertension, diabetes, mental health
condition during pregnancy, adequacy of prenatal care, education, and type of hospital.
Odds of an adverse obstetric outcome were estimated using logistic regression.
Results
Of 2794 women with unstable housing identified, 83.0% (n = 2318) had an exact propensity
score–matched control. Women with an unstable housing code had higher odds of preterm
birth (odds ratio, 1.2, 95% confidence interval, 1.0–1.4, P < .05), preterm labor (odds ratio, 1.4, 95% confidence interval, 1.2–1.6, P < .001), long length of stay (odds ratio, 1.6, 95% confidence interval, 1.4–1.8,
P < .001), emergency department visits within 3 months (odds ratio, 2.4, 95% confidence
interval, 2.1–2.8, P < .001) and 1 year after birth (odds ratio, 2.7, 95% confidence interval, 2.4–3.0,
P < .001), and readmission within 3 months (odds ratio, 2.7, 95% confidence interval,
2.2–3.4, P < .0014) and 1 year after birth (odds ratio, 2.6, 95% confidence interval, 2.2–3.0,
P < .001).
Conclusion
Unstable housing documentation is associated with adverse obstetric outcomes and high
health care utilization. Housing and supplemental income for pregnant women should
be explored as a potential intervention to prevent preterm birth and prevent increased
health care utilization.
Key words
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Article info
Publication history
Accepted:
September 24,
2019
Received in revised form:
September 19,
2019
Received:
June 24,
2019
Footnotes
This work was supported by the University of California, San Francisco Preterm Birth Initiative, United States. The authors receiving funding support from the University of California, San Francisco, California Preterm Birth Initiative helped design the study, analyze the data, write the report, and decide to submit it for publication, although the funders did not influence decisions about how to analyze and report the data.
The authors report no conflict of interest.
Cite this article as: Pantell MS, Baer RJ, Torres J, et al. Associations between unstable housing, obstetric outcomes, and perinatal health care utilization. Am J Obstet Gynecol MFM 2019;1:100053.
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