Racial and Ethnic Disparities in Early Pregnancy Loss (EPL) Among U.S. Emergency Department Visits: The Compounding Role of Advanced Maternal Age.

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.