740 - Analyzing Racial and Ethnic Disparities in Obstetric Emergency Department Visit Outcomes Before and During the Coronavirus Pandemic

Publication Number: 740.3616

Anusha Attre, University of Connecticut School of Medicine, Farmington, CT, United States; Andrea D. Shields, University of Connecticut Health, Farmington, CT, United States; Amy Hunter, UCONN Health, Farmington, CT, United States

Background: BIPOC communities face a higher risk of pregnancy-induced hypertension (PIH) and gestational diabetes (GDM), respectively. Both conditions increase the risk for fetal, neonatal, and maternal complications and death. While there has been growing acknowledgement of how the COVID-19 pandemic exacerbated health disparities, there is limited research on how COVID-19 specifically impacted pregnancy-related outcomes in BIPOC communities.

Objective: This study analyzed pregnant females 18-35 years old captured in the Nationwide Emergency Department Sample (NEDS) between January 2019 to December 2020 to determine racial and ethnic disparities in obstetric-related ED visits before (2019) and during (2020) the COVID-19 pandemic.

Design/Methods: NEDS captures patients’ race/ethnicity as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, Asian/Pacific Islander (AAPI), Native American (AIAN), Other, and Missing. Descriptive statistics were calculated using univariate and bivariate analysis. Rates were calculated per 1,000 ED visits. Racial disproportionality was measured using the disproportionality representation index (DRI). Racial disparity was measured using the disparity index (DI).

Results: NEDS captured 61.1 million ED visits in 2019 and 2020, representing 266 million ED visits nationally. Of these, 6,649,312 (2.5%) were pregnancy-related. Pregnancy occurred most often in individuals who were NHW (40.4%); the median age was 26 years. Though total and pregnancy-related ED visits decreased between 2019 and 2020, there was an increase in the rate of pregnancy-related ED visits among individuals identifying as Other (7.6% increase) and Hispanic (5.2% increase).

The rate of GDM was highest among AAPIs during both years (219.1 per 1,000 ED visits). Before COVID-19, all BIPOCs were more likely to have a GDM-related ED visit compared to NHW. The disparity was exacerbated for all racial/ethnic groups except AIAN during COVID-19.

NHB and Hispanic individuals were more likely than NHW to have a PIH-related ED visits before and during COVID-19. All other groups were less likely than NHW to have a PIH-related ED visit before and during COVID-19.

Conclusion(s): This study showed the negative impact of COVID-19 on preexisting disparities in obstetric ED utilization for GDM and PIH. While there are variations in DIs between racial/ethnic groups over time, the data shows these outcomes may be aggravated during public health emergencies. When planning for future public health crises, strategies to reduce morbidity must incorporate cultural competency and cultural humility to reach disproportionately impacted groups.

Demographic Characteristics


Obstetric Outcomes Among Pregnancy Related Outcomes


Disproportionality and Disparity


Demographic Characteristics


Obstetric Outcomes Among Pregnancy Related Outcomes


Disproportionality and Disparity