Accepted for/Published in: JMIR Pediatrics and Parenting
Date Submitted: Apr 19, 2022
Open Peer Review Period: Apr 19, 2022 - Jun 14, 2022
Date Accepted: Sep 14, 2022
Date Submitted to PubMed: Sep 14, 2022
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Assessing the Racial and Socioeconomic Disparities in Postpartum Depression Using Population-level Hospital Discharge Data: Longitudinal Retrospective Study
ABSTRACT
Background:
In the U.S., over 3.6 million deliveries occur each year. Among them, up to 20% (~700k) of women experience postpartum depression (PPD), according to the Center for Disease Control and Prevention. Absence of accurate reporting and diagnosis has made phenotyping patients with PPD difficult. Existing literature has shown that factors such as race, socioeconomic status, and history of substance abuse are associated with differential risks of PPD. However, limited research has considered differential temporal associations with the outcome.
Objective:
To estimate the disparities in the risk of postpartum depression (PPD) and time to diagnosis for patients of different racial and socioeconomic backgrounds.
Methods:
This is a longitudinal retrospective study using the statewide hospital discharge data from Maryland. We identified 160,066 individuals who had a hospital delivery from 2017 to 2019. We applied logistic regression and Cox regression to study the risks of PPD across racial and socioeconomic strata. We used multinomial regression to estimate the risks of PPD at different postpartum stages.
Results:
The cumulative incidence of PPD was highest for White (14.7%) and lowest for Asian and Pacific Islander (2.4%). Compared to White patients, PPD was less likely to occur for Black patients (OR 0.32, 95% CI 0.31-0.34), Asian or Pacific Islander patients (0.16, 95% CI 0.14-0.19), and Hispanic patients (OR 0.2, 95% CI 0.19-0.22). Similar findings were observed from the Cox regression analysis. Multinomial regression showed that compared to White patients, Black patients (RR 2.23, 95% CI 1.82-2.74), and Asian and Pacific Islander patients (RR 2.5, 95% CI 1.47 - 4.25) were more likely to be diagnosed with PPD after 8 weeks of delivery.
Conclusions:
Compared to White patients, PPD diagnosis is less likely to occur in individuals of other races. We found disparate timing in PPD diagnosis across different racial groups and socioeconomic backgrounds. Our findings serve to enhance intervention strategies and policies for phenotyping patients of highest risks and to highlight needs in data quality to support future work on racial disparities in PPD.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.