Racial disparities in economic and clinical outcomes of pregnancy among medicaid recipients

Shun Zhang, Kathryn Cardarelli, Ruth Shim, Jiali Ye, Karla L. Booker, George Rust

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


To explore racial-ethnic disparities in adverse pregnancy outcomes among Medicaid recipients, and to estimate excess Medicaid costs associated with the disparities. Cross-sectional study of adverse pregnancy outcomes and Medicaid payments using data from Medicaid Analytic eXtract files on all Medicaid enrollees in fourteen southern states. Compared to other racial and ethnic groups, African American women tended to be younger, more likely to have a Cesarean section, to stay longer in the hospital and to incur higher Medicaid costs. African-American women were also more likely to experience preeclampsia, placental abruption, preterm birth, small birth size for gestational age, and fetal death/stillbirth. Eliminating racial disparities in adverse pregnancy outcomes (not counting infant costs), could generate Medicaid cost savings of 114 to 214 million per year in these 14 states. Despite having the same insurance coverage and meeting the same poverty guidelines for Medicaid eligibility, African American women have a higher rate of adverse pregnancy outcomes than White or Hispanic women. Racial disparities in adverse pregnancy outcomes not only represent potentially preventable human suffering, but also avoidable economic costs. There is a significant financial return-on-investment opportunity tied to eliminating racial disparities in birth outcomes. With the Affordable Care Act expansion of Medicaid coverage for the year 2014, Medicaid could be powerful public health tool for improving pregnancy outcomes.

Original languageEnglish
Pages (from-to)1518-1525
Number of pages8
JournalMaternal and Child Health Journal
Issue number8
StatePublished - Oct 2013

Bibliographical note

Funding Information:
Financial support for this research was provided by the Agency for Healthcare Research and Quality (AHRQ) grant #1R24HS019470 and by a grant from the Healthcare Georgia Foundation.


  • Adverse maternal-child health outcomes and eliminating disparities
  • Disparities
  • Economic burden
  • Medicaid

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Racial disparities in economic and clinical outcomes of pregnancy among medicaid recipients'. Together they form a unique fingerprint.

Cite this