The Mitigating Effects of Telehealth Uptake on Disparities in Maternal Care Access, Quality, Outcomes, and Expenditures, United States, 2018-2022 (ICPSR 39023)
Version Date: May 12, 2025 View help for published
Principal Investigator(s): View help for Principal Investigator(s)
Peiyin Hung, University of South Carolina;
Xiaoming Li, University of South Carolina
https://doi.org/10.3886/ICPSR39023.v3
Version V3 (see more versions)
Summary View help for Summary
This study explores whether perinatal telehealth uptake has mitigated the pandemic's effects on disparities in maternal care access, quality, and outcomes by race, ethnicity, and rural or urban residence. Research to date has approached this question in several ways. First, researchers have utilized census data to assess whether community-wide broadband infrastructure exists to support the use of telehealth services in areas with high travel times to maternal care units. Findings suggest that socioeconomically disadvantaged communities face significant barriers to maternity care access, both with substantial travel burdens and inadequate digital access to facilitate telehealth services. Second, to examine maternal care quality, researchers have employed South Carolina hospital-based claims data and vital statistics to identify racial, ethnic, and urban/rural disparities in rates of cesarean delivery before and during the COVID-19 pandemic period. Results indicate that cesarean rates differed by rural vs. urban facility locations and racial and ethnic groups but observed disparities were not significantly exacerbated by the pandemic. Third, using South Carolina hospital-based claims data and COVID-19 testing data, researchers found significant racial, ethnic, and rural disparities in postpartum readmissions involving mental health and substance use disorders from childbirth discharge through one year postpartum during the COVID-19 pandemic. Finally, drawing on data from the National COVID Cohort Collaborative (N3C), research has shown that hybrid care increased substantially during the COVID-19 public health emergency, but pregnant people living in rural areas had lower levels of hybrid care than urban people, and individuals who belonged to racial and ethnic minority groups were more likely to have hybrid care than White individuals.
Future research will investigate the impact of the COVID-19 pandemic and perinatal telehealth uptake on additional maternity care and birth outcomes by race, ethnicity, and urbanicity. The study also aims to assess how state-level telehealth policies relate to perinatal telehealth uptake by race, ethnicity, and urbanicity, and to develop a model to predict long-term changes in maternal care access, quality, outcomes, and expenditures, with and without state telehealth policies.
The ICPSR provides variable-level metadata for the data associated with this study. The actual data may only be available from the Principal Investigator directly. The variable descriptions available through ICPSR also include information regarding the source of each variable listed, as does the Data Source field of these metadata.
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Date of Collection View help for Date of Collection
Universe View help for Universe
DS1: Residential ZIP code tabulation areas in the United States. (Residential ZCTAs are those with at least one resident in 2020 according to the American Community Survey.)
DS2: Individuals who gave birth in South Carolina between January 2018 and December 2021.
DS3: Individuals who gave birth in South Carolina and were included in the COVID-19 registry files (statewide testing data) between March 1, 2020, and January 31, 2022.
DS4: Individuals who gave birth in the United States between June 1, 2018, and May 31, 2022.
Data Source View help for Data Source
For DS3, data on childbirths were derived from all-payer hospital discharge claims obtained from the South Carolina Department of Public Health.
The 2010 Rural-Urban Commuting Codes were used to classify ZCTAs as rural or urban.
Childbirth data were linked to all-payer hospital discharge claims for childbirth obtained from the South Carolina Revenue and Fiscal Affairs Office.
Population-weighted centroids for each ZCTA were taken from the U.S. Department of Housing and Urban Development's ZIP Code Population Weighted Centroids 2020 data.
For DS1, data on internet access and demographic characteristics of ZIP code tabulation areas (ZCTAs) comes from the 2020 American Community Survey.
For DS4, data were taken from electronic health records included in the National COVID Cohort Collaborative (NC3) data enclave.
Locations of hospital maternity units were taken from the 2020 American Hospital Association annual survey.
COVID-19 testing data came from the statewide universal COVID-19 registry file, a database of all positive and negative COVID-19 test results also maintained by DHEC. The South Carolina Revenue and Fiscal Affairs Office (RFA) linked these two data sources and provided deidentified linked data to the researchers.
For DS2, data on cesarean childbirths were derived from South Carolina birth certificates from January 2018 through December 2021 obtained from the South Carolina Department of Public Health (the former South Carolina Department of Health and Environmental Control, DHEC prior to July 1, 2024).
Original Release Date View help for Original Release Date
2024-02-19
Version History View help for Version History
2025-05-12 Updated variable-level metadata for DS1, DS2, and DS3. Added variable-level metadata for DS4.
2024-11-05 Added variable-level metadata for DS2 and DS3. Updated dataset name for DS1. Made minor updates to study metadata.
Notes
The public-use data files in this collection are available for access by the general public. Access does not require affiliation with an ICPSR member institution.