Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system

Min Kyoung Kim, Seung Mi Lee, Sung Hee Bae, Hyun Joo Kim, Nam Gu Lim, Seok-Jun Yoon, Jin Yong Lee, Min Woo Jo

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. Korea has been adopting a universal healthcare system. All Korean citizens must be enrolled National Health Insurance (NHI) or be recipient of Medical Aid (MA). In addition, Korean government launched a financial support system for antenatal care for all pregnant women in 2008. Therefore, in theory, there is no financial barrier to receive prenatal cares regardless of someone's social class. However, it is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. The purpose of this study was to investigate whether socioeconomic status affects pregnancy outcomes after the introduction of this support system, which allows all pregnant women to receive adequate prenatal care regardless of socioeconomic status. METHODS: Using the National Health Insurance database in Korea, we selected women who gave birth between January 1, 2010 and December 31, 2010. As a proxy indicator reflecting socioeconomic status, we classified subjects as MA recipient ("low" SES) or a NHI beneficiary ("middle/high" SES). RESULTS: In the MA group, 29.4% women received inadequate prenatal care, compared to 11.4% in the NHI group. Mothers in the MA group were more likely to have an abortion (30.1%), rather than deliver a baby, than those in the NHI group (20.7%, P < 0.001). Mothers in the MA group were also more likely to undergo a Caesarean delivery (45.8%; NHI group: 39.6%, P < 0.001), and have preeclampsia (1.5%; NHI group: 0.6%, P < 0.001), obstetric hemorrhage (4.7%; NHI group: 3.9%, P = 0.017), and a preterm delivery (2.1%; NHI group: 1.4%, P < 0.001) than those in the NHI group. CONCLUSIONS: Women in the MA group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery, and obstetrical hemorrhage than those in the NHI group Therefore, health authorities should consider investigating what kind of barriers exist or what factors may affect these inequitable outcomes.

Original languageEnglish
Number of pages1
JournalInternational Journal for Equity in Health
Volume17
Issue number1
DOIs
Publication statusPublished - 2018 Jan 5

Fingerprint

Pregnancy Complications
National Health Programs
Pregnancy Outcome
Social Class
Delivery of Health Care
Prenatal Care
Korea
Pre-Eclampsia
Pregnant Women
Mothers
Hemorrhage
Financial Support
Induced Abortion
Proxy
Insurance Benefits
Obstetrics
Economics
Parturition
Databases

Keywords

  • Health equity
  • National Health Insurance
  • Prenatal care
  • Preterm delivery
  • Socioeconomic status

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system. / Kim, Min Kyoung; Lee, Seung Mi; Bae, Sung Hee; Kim, Hyun Joo; Lim, Nam Gu; Yoon, Seok-Jun; Lee, Jin Yong; Jo, Min Woo.

In: International Journal for Equity in Health, Vol. 17, No. 1, 05.01.2018.

Research output: Contribution to journalArticle

Kim, Min Kyoung ; Lee, Seung Mi ; Bae, Sung Hee ; Kim, Hyun Joo ; Lim, Nam Gu ; Yoon, Seok-Jun ; Lee, Jin Yong ; Jo, Min Woo. / Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system. In: International Journal for Equity in Health. 2018 ; Vol. 17, No. 1.
@article{3439d699b1f443e3b542a60e07ae447f,
title = "Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system",
abstract = "BACKGROUND: Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. Korea has been adopting a universal healthcare system. All Korean citizens must be enrolled National Health Insurance (NHI) or be recipient of Medical Aid (MA). In addition, Korean government launched a financial support system for antenatal care for all pregnant women in 2008. Therefore, in theory, there is no financial barrier to receive prenatal cares regardless of someone's social class. However, it is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. The purpose of this study was to investigate whether socioeconomic status affects pregnancy outcomes after the introduction of this support system, which allows all pregnant women to receive adequate prenatal care regardless of socioeconomic status. METHODS: Using the National Health Insurance database in Korea, we selected women who gave birth between January 1, 2010 and December 31, 2010. As a proxy indicator reflecting socioeconomic status, we classified subjects as MA recipient ({"}low{"} SES) or a NHI beneficiary ({"}middle/high{"} SES). RESULTS: In the MA group, 29.4{\%} women received inadequate prenatal care, compared to 11.4{\%} in the NHI group. Mothers in the MA group were more likely to have an abortion (30.1{\%}), rather than deliver a baby, than those in the NHI group (20.7{\%}, P < 0.001). Mothers in the MA group were also more likely to undergo a Caesarean delivery (45.8{\%}; NHI group: 39.6{\%}, P < 0.001), and have preeclampsia (1.5{\%}; NHI group: 0.6{\%}, P < 0.001), obstetric hemorrhage (4.7{\%}; NHI group: 3.9{\%}, P = 0.017), and a preterm delivery (2.1{\%}; NHI group: 1.4{\%}, P < 0.001) than those in the NHI group. CONCLUSIONS: Women in the MA group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery, and obstetrical hemorrhage than those in the NHI group Therefore, health authorities should consider investigating what kind of barriers exist or what factors may affect these inequitable outcomes.",
keywords = "Health equity, National Health Insurance, Prenatal care, Preterm delivery, Socioeconomic status",
author = "Kim, {Min Kyoung} and Lee, {Seung Mi} and Bae, {Sung Hee} and Kim, {Hyun Joo} and Lim, {Nam Gu} and Seok-Jun Yoon and Lee, {Jin Yong} and Jo, {Min Woo}",
year = "2018",
month = "1",
day = "5",
doi = "10.1186/s12939-017-0715-7",
language = "English",
volume = "17",
journal = "International Journal for Equity in Health",
issn = "1475-9276",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system

AU - Kim, Min Kyoung

AU - Lee, Seung Mi

AU - Bae, Sung Hee

AU - Kim, Hyun Joo

AU - Lim, Nam Gu

AU - Yoon, Seok-Jun

AU - Lee, Jin Yong

AU - Jo, Min Woo

PY - 2018/1/5

Y1 - 2018/1/5

N2 - BACKGROUND: Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. Korea has been adopting a universal healthcare system. All Korean citizens must be enrolled National Health Insurance (NHI) or be recipient of Medical Aid (MA). In addition, Korean government launched a financial support system for antenatal care for all pregnant women in 2008. Therefore, in theory, there is no financial barrier to receive prenatal cares regardless of someone's social class. However, it is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. The purpose of this study was to investigate whether socioeconomic status affects pregnancy outcomes after the introduction of this support system, which allows all pregnant women to receive adequate prenatal care regardless of socioeconomic status. METHODS: Using the National Health Insurance database in Korea, we selected women who gave birth between January 1, 2010 and December 31, 2010. As a proxy indicator reflecting socioeconomic status, we classified subjects as MA recipient ("low" SES) or a NHI beneficiary ("middle/high" SES). RESULTS: In the MA group, 29.4% women received inadequate prenatal care, compared to 11.4% in the NHI group. Mothers in the MA group were more likely to have an abortion (30.1%), rather than deliver a baby, than those in the NHI group (20.7%, P < 0.001). Mothers in the MA group were also more likely to undergo a Caesarean delivery (45.8%; NHI group: 39.6%, P < 0.001), and have preeclampsia (1.5%; NHI group: 0.6%, P < 0.001), obstetric hemorrhage (4.7%; NHI group: 3.9%, P = 0.017), and a preterm delivery (2.1%; NHI group: 1.4%, P < 0.001) than those in the NHI group. CONCLUSIONS: Women in the MA group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery, and obstetrical hemorrhage than those in the NHI group Therefore, health authorities should consider investigating what kind of barriers exist or what factors may affect these inequitable outcomes.

AB - BACKGROUND: Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. Korea has been adopting a universal healthcare system. All Korean citizens must be enrolled National Health Insurance (NHI) or be recipient of Medical Aid (MA). In addition, Korean government launched a financial support system for antenatal care for all pregnant women in 2008. Therefore, in theory, there is no financial barrier to receive prenatal cares regardless of someone's social class. However, it is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. The purpose of this study was to investigate whether socioeconomic status affects pregnancy outcomes after the introduction of this support system, which allows all pregnant women to receive adequate prenatal care regardless of socioeconomic status. METHODS: Using the National Health Insurance database in Korea, we selected women who gave birth between January 1, 2010 and December 31, 2010. As a proxy indicator reflecting socioeconomic status, we classified subjects as MA recipient ("low" SES) or a NHI beneficiary ("middle/high" SES). RESULTS: In the MA group, 29.4% women received inadequate prenatal care, compared to 11.4% in the NHI group. Mothers in the MA group were more likely to have an abortion (30.1%), rather than deliver a baby, than those in the NHI group (20.7%, P < 0.001). Mothers in the MA group were also more likely to undergo a Caesarean delivery (45.8%; NHI group: 39.6%, P < 0.001), and have preeclampsia (1.5%; NHI group: 0.6%, P < 0.001), obstetric hemorrhage (4.7%; NHI group: 3.9%, P = 0.017), and a preterm delivery (2.1%; NHI group: 1.4%, P < 0.001) than those in the NHI group. CONCLUSIONS: Women in the MA group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery, and obstetrical hemorrhage than those in the NHI group Therefore, health authorities should consider investigating what kind of barriers exist or what factors may affect these inequitable outcomes.

KW - Health equity

KW - National Health Insurance

KW - Prenatal care

KW - Preterm delivery

KW - Socioeconomic status

UR - http://www.scopus.com/inward/record.url?scp=85059797948&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059797948&partnerID=8YFLogxK

U2 - 10.1186/s12939-017-0715-7

DO - 10.1186/s12939-017-0715-7

M3 - Article

C2 - 29304810

AN - SCOPUS:85059797948

VL - 17

JO - International Journal for Equity in Health

JF - International Journal for Equity in Health

SN - 1475-9276

IS - 1

ER -