Abstract
Importance: Postpartum readmission (PPR) affects up to 3% of all births in the U.S.1,2 PPR is often avoidable, especially for psychiatric disease and substance use disorders.3,4 Many mothers experience challenges accessing mental health and substance use treatment during perinatal periods. Nursing science prioritizes equitable care5 highlighting the critical need to address this public health issue.
Aim: To investigate the intersections of residential rurality and race/ethnicity on all-cause, mental health disorders and substance use disorders (SUD) PPR throughout 1-year postpartum.
Methods: A statewide retrospective cohort study using birth certificates linked to all-payer hospital data for mothers in South Carolina from 2018-2021. Our main exposures were maternal race/ethnicity and rural-urban residence. For administrative censoring, PPR was defined as an inpatient readmission at 4 time points: within 42, 90, 180 and 365 days after initial birth hospitalization discharge using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) diagnoses and procedure codes. We report Cox proportional hazard ratios (HR) and 95% confidence intervals (CI), adjusted for prenatal (e.g., education) and clinical (e.g., mode of birth) factors.
Results: Of 195,311 mothers, 28,617 (14.6%) resided in rural residential areas. Using urban residence as the reference group, for rural mothers after adjustment, all-cause PPR: HR 1.15 (CI: 1.06, 1.25); mental health related PPR: HR 1.06 (CI:0.93, 1.20); and SUD PPR: HR 1.13 (CI: 0.96, 1.33). In considering the interaction between maternal residence and race/ethnicity using urban and Non-Hispanic (NH) White as the reference group, all-cause PPR in NH Black rural mothers: HR 0.86 (CI: 0.77, 0.96), Hispanic rural mothers: HR 0.53 (CI: 0.33, 0.85); mental health related PPR in NH Black rural mothers: HR 0.92 (CI: 0.75, 1.12), Hispanic rural mothers: HR 0.45 (CI: 0.11, 1.87); for SUD PPR in NH Black rural mothers: HR 0.98 (CI: 0.76, 1.26), and Hispanic rural mothers: HR 0.59 (CI: 0.08, 4.44).
Conclusions: Rural mothers have a higher risk of all-cause related PPR, yet differences specific to mental health and SUD PPR among this group were less apparent. Rurality interacts with race/ethnicity to influence all-cause PPR rates, where NH Black and Hispanic mothers in rural areas show a reduced risk. Nurses should prioritize discharge planning to consider the distinct needs of rural mothers at increased risk.
Notes
References:
1. Lui B, Khusid E, Tangel VE, Jiang SY, Abramovitz SE, Oxford CM, White RS. Disparities in postpartum readmission by patient- and hospital-level social risk factors in the United States: a retrospective multistate analysis, 2015-2020. International Journal of Obstetric Anesthesia. 2024;45:103998. doi:10.1016/j.ijoa.2024.103998.
2. Tucker CM, Ma C, Mujahid M, Butwick AJ, Girsen AI, Gibbs RS, Carmichael SL. Trends in racial/ethnic disparities of postpartum hospital readmissions in California from 1997-2018. AJOG Global Reports. 2024;4:100331. doi:10.1016/j.xagr.2024.100331.
3. Hung P, Zhang J, Chen S, Harrison S, Boghossian NS, Li X. A hidden crisis: postpartum readmissions for mental health and substance use disorders in rural and racial minority communities. American Journal of Obstetrics and Gynecology. 2024. doi:10.1016/j.ajog.2024.05.047.
4. Brown CC, Kuhn S, Stringfellow K, Moore JE, Ayers B. Association between mental health conditions at the hospitalization for birth and postpartum hospital readmission. Journal of Women’s Health. 2023;32(9):982-991. doi:10.1089/jwh.2022.0481.
5. Hassmiller SB, Wakefield MK. The future of nursing 2020-2030: charting a path to achieve health equity. Nursing Outlook. 2022;70(6 Suppl 1):S1-S9. doi:10.1016/j.outlook.2022.05.013.
Sigma Membership
Alpha Xi
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Cohort
Research Approach
Quantitative Research
Keywords:
Health Equity or Social Determinants of Health, Public and Community Health, Postpartum Readmissions, Mental Health
Recommended Citation
Tucker, Curisa M.; Hung, Peiyin; Ma, Yunqing; Liu, Jihong; Campbell, Berry A.; Li, Xiaoming; and Zhang, Jiajia, "Disparities in Mental Health and Substance Use Disorder Related Postpartum Readmissions" (2025). International Nursing Research Congress (INRC). 222.
https://www.sigmarepository.org/inrc/2025/presentations_2025/222
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Disparities in Mental Health and Substance Use Disorder Related Postpartum Readmissions
Seattle, Washington, USA
Importance: Postpartum readmission (PPR) affects up to 3% of all births in the U.S.1,2 PPR is often avoidable, especially for psychiatric disease and substance use disorders.3,4 Many mothers experience challenges accessing mental health and substance use treatment during perinatal periods. Nursing science prioritizes equitable care5 highlighting the critical need to address this public health issue.
Aim: To investigate the intersections of residential rurality and race/ethnicity on all-cause, mental health disorders and substance use disorders (SUD) PPR throughout 1-year postpartum.
Methods: A statewide retrospective cohort study using birth certificates linked to all-payer hospital data for mothers in South Carolina from 2018-2021. Our main exposures were maternal race/ethnicity and rural-urban residence. For administrative censoring, PPR was defined as an inpatient readmission at 4 time points: within 42, 90, 180 and 365 days after initial birth hospitalization discharge using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) diagnoses and procedure codes. We report Cox proportional hazard ratios (HR) and 95% confidence intervals (CI), adjusted for prenatal (e.g., education) and clinical (e.g., mode of birth) factors.
Results: Of 195,311 mothers, 28,617 (14.6%) resided in rural residential areas. Using urban residence as the reference group, for rural mothers after adjustment, all-cause PPR: HR 1.15 (CI: 1.06, 1.25); mental health related PPR: HR 1.06 (CI:0.93, 1.20); and SUD PPR: HR 1.13 (CI: 0.96, 1.33). In considering the interaction between maternal residence and race/ethnicity using urban and Non-Hispanic (NH) White as the reference group, all-cause PPR in NH Black rural mothers: HR 0.86 (CI: 0.77, 0.96), Hispanic rural mothers: HR 0.53 (CI: 0.33, 0.85); mental health related PPR in NH Black rural mothers: HR 0.92 (CI: 0.75, 1.12), Hispanic rural mothers: HR 0.45 (CI: 0.11, 1.87); for SUD PPR in NH Black rural mothers: HR 0.98 (CI: 0.76, 1.26), and Hispanic rural mothers: HR 0.59 (CI: 0.08, 4.44).
Conclusions: Rural mothers have a higher risk of all-cause related PPR, yet differences specific to mental health and SUD PPR among this group were less apparent. Rurality interacts with race/ethnicity to influence all-cause PPR rates, where NH Black and Hispanic mothers in rural areas show a reduced risk. Nurses should prioritize discharge planning to consider the distinct needs of rural mothers at increased risk.
Description
Postpartum readmission is preventable and costly, especially for mental health and substance use. Rural mothers face higher PPR risks due to access barriers, underscoring the nursing priority for equitable postpartum care. We examine how rurality and race/ethnicity affect all-cause, mental health, and substance use PPR within one year. Results show higher PPR risk in rural mothers overall, with NH Black and Hispanic rural mothers showing lower all-cause PPR risk than NH White urban mothers.