Ms. Jocelyn Wilder, doctoral student in Epidemiology and Biostatistics at the University of Illinois at Chicago School of Public Health, received a $40,000 award from the Agency for Healthcare Research and Quality (AHRQ) to examine racial, ethnic and language disparities, as well as the effects of birthing facility characteristics, on maternal tetanus, diphtheria and pertussis (Tdap) immunization rates.
[Photo: Ms. Jocelyn Wilder]
Despite high immunization rates among children, pertussis rates have been steadily increasing since 1980. Much of the increase has been among adolescents and adults. However, the highest rates of complications, hospitalizations, and deaths are among infants who have not yet completed their diphtheria, tetanus and pertussis (Dtap) immunization series. Parents, specifically mothers, are cited as the most common source of infection in infants due to waning immunity in adults.
This study will focus on women covered by Medicaid who gave birth between 2012 and 2014 in Louisiana, where 70 percent of births are paid for by Medicaid. Evidence has shown that racial and ethnic disparities persist in tertiary care access, such as immunization, among Medicaid and Medicare recipients, pregnant women and children. Tdap receipt was higher among publicly insured non-Hispanic (NH) Whites (17.6 percent) compared to publicly insured NH Blacks (8.4 percent) and publicly insured Hispanics (15.3 percent). “Most studies are not looking at insurance at all because, in theory, they should all have equal access, because they all have the ability the pay,” explained Ms. Wilder.
In addition to examining disparities of Tdap receipt on an individual level, Wilder will look at differences in birthing facility characteristics, i.e. their size, location, whether they have an OB/GYN residency program, etc., to see whether these characteristics minimize or exaggerate any individual disparities. “I want to get at how the system-level attributes, policies and characteristics impact health at the individual level so that they take control of the system. Are [hospitals] acting as safety nets?” Wilder asked. By approaching the issue on both an individual and systemic level, a new wealth of information will be added to this field of research.