Journal of racial and ethnic health disparities · 2026
Racial and Ethnic Disparities in Early Pregnancy Loss (EPL) Among U.S. Emergency Department Visits: The Compounding Role of Advanced Maternal Age.
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Noor Amamah, Imanpour Sara, Dun-Dery Elvis J
Аннотация
INTRODUCTION: Early pregnancy loss (EPL) is one of the most prevalent pregnancy complications in the United States, with maternal age consistently identified as a key correlate. However, limited evidence exists regarding the influence of racial, ethnic, and socioeconomic disadvantage on the settings in which EPL is managed.
METHODS: This retrospective observational study utilized the 2019 Nationwide Emergency Department Sample. The analytic sample included pregnancy-related emergency department visits by individuals aged 15 to 49 years. The primary outcome was the presence of an ICD-10-CM diagnosis code for EPL (O03.x) during a visit, rather than the actual occurrence of EPL. Key exposures included maternal age and race and ethnicity. Survey-weighted logistic regression models were adjusted for insurance type, patient location, and hospital and visit characteristics.
RESULTS: Among 889,060 pregnancy-related ED visits, 43,275 (4.9%) carried an EPL diagnosis code (mean age, 28.8 vs. 27.2 years; p < 0.001). Visits by individuals aged 35 years and older demonstrated higher odds of EPL coding than those aged 15-24 years (aOR 2.26; 95% CI 2.17-2.34). Elevated odds were likewise observed among Hispanic (aOR 1.27; 1.19-1.35) and Asian/Pacific Islander (aOR 1.15; 1.03-1.28) pregnant individuals relative to White pregnant individuals, and among self-pay visits (aOR 2.28; 2.05-2.53). Regional and rural-urban differences were pronounced, and no age-by-race and ethnicity interaction was statistically significant.
CONCLUSION: Racial, ethnic, insurance-related, and geographic differences in EPL-coded ED visits were evident in 2019 and operated across the age distribution rather than widening at AMA. These estimates establish a pre-Dobbs, pre-pandemic baseline against which subsequent shifts in EPL-related emergency care may be evaluated.
METHODS: This retrospective observational study utilized the 2019 Nationwide Emergency Department Sample. The analytic sample included pregnancy-related emergency department visits by individuals aged 15 to 49 years. The primary outcome was the presence of an ICD-10-CM diagnosis code for EPL (O03.x) during a visit, rather than the actual occurrence of EPL. Key exposures included maternal age and race and ethnicity. Survey-weighted logistic regression models were adjusted for insurance type, patient location, and hospital and visit characteristics.
RESULTS: Among 889,060 pregnancy-related ED visits, 43,275 (4.9%) carried an EPL diagnosis code (mean age, 28.8 vs. 27.2 years; p < 0.001). Visits by individuals aged 35 years and older demonstrated higher odds of EPL coding than those aged 15-24 years (aOR 2.26; 95% CI 2.17-2.34). Elevated odds were likewise observed among Hispanic (aOR 1.27; 1.19-1.35) and Asian/Pacific Islander (aOR 1.15; 1.03-1.28) pregnant individuals relative to White pregnant individuals, and among self-pay visits (aOR 2.28; 2.05-2.53). Regional and rural-urban differences were pronounced, and no age-by-race and ethnicity interaction was statistically significant.
CONCLUSION: Racial, ethnic, insurance-related, and geographic differences in EPL-coded ED visits were evident in 2019 and operated across the age distribution rather than widening at AMA. These estimates establish a pre-Dobbs, pre-pandemic baseline against which subsequent shifts in EPL-related emergency care may be evaluated.