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Table 2 Maternal and Infant Characteristics Delivering in Non-Obstetric and Obstetric Hospitals by Empiric Maternal Level of Care in California, Missouri, and Pennsylvania, 2000–2009

From: Identifying individual hospital levels of maternal care using administrative data

Variable Non-Obstetric N = 10,859 (0.2%) Level I N = 467,368 (6.8%) Level II N = 2,861,713 (41.5%) Level III N = 2,442,605 (35.4%) Level IV N = 1,113,055 (16.1%) P-value
State       < 0.001
 CA 4141 (0.1%) 178,951 (3.6%) 2,079,001 (41.8%) 2,055,616 (41.3%) 661,168 (13.3%)  
 MO 4484 (0.6%) 87,528 (12.1%) 268,344 (37.0%) 106,355 (14.7%) 257,647 (35.6%)  
 PA 2234 (0.2%) 200,889 (16.9%) 514,368 (43.1%) 280,634 (23.5%) 194,240 (16.3%)  
Deliveries/year (median, IQR) 74 (59–87) 443 (298–570) 1562 (1099–2091) 3318 (2648–4041) 4511 (3035–6644) < 0.001
Maternal characteristics, N (%) (unless otherwise noted)
 Maternal age (years; median, IQR) 25 (21–30) 26 (22–31) 27 (23–32) 28 (24–33) 28 (23–33) < 0.001
 Race       < 0.001
  White, Non-Hispanic 8943 (82.4%) 332,532 (71.2%) 1,306,403 (45.7%) 935,697 (38.3%) 492,285 (44.2%)  
  Black, Non-Hispanic 289 (2.7%) 20,293 (4.3%) 182,813 (6.4%) 170,257 (7.0%) 158,016 (14.2%)  
  Hispanic 1025 (9.4%) 85,636 (18.3%) 1,062,409 (37.1%) 975,757 (40.0%) 315,668 (28.4%)  
  Asian/Pacific Islander 195 (1.8%) 13,680 (2.9%) 249,544 (8.7%) 312,415 (12.8%) 118,043 (10.6%)  
  Other 407 (3.8%) 15,227 (3.3%) 60,544 (2.1%) 48,479 (2.0%) 29,043 (2.6%)  
 Insurance       < 0.001
  FFS 2184 (20.1%) 75,691 (16.2%) 188,818 (6.6%) 120,363 (4.9%) 56,676 (5.1%)  
  HMO 1690 (15.6%) 134,753 (28.8%) 1,298,549 (45.4%) 1,270,782 (52.0%) 527,953 (47.4%)  
  Public 5864 (54.0%) 227,233 (48.6%) 1,264,669 (44.2%) 981,462 (40.2%) 493,018 (44.3%)  
  Other 1121 (10.3%) 29,691 (6.4%) 109,677 (3.8%) 69,998 (2.9%) 35,408 (3.2%)  
 Education       < 0.001
  No High School 520 (4.8%) 30,481 (6.5%) 256,725 (9.0%) 197,890 (8.1%) 69,522 (6.3%)  
  Some High School 2217 (20.4%) 82,707 (17.7%) 490,139 (17.1%) 393,694 (16.1%) 172,056 (15.5%)  
  High School Diploma/GED 4364 (40.2%) 162,316 (34.7%) 812,643 (28.4%) 608,347 (24.9%) 276,107 (24.8%)  
  At least Some College 3636 (33.5%) 186,899 (40.0%) 1,260,098 (44.0%) 1,180,600 (48.3%) 563,492 (50.6%)  
  Missing 122 (1.1%) 4965 (1.1%) 42,108 (1.5%) 62,074 (2.5%) 31,878 (2.9%)  
Maternal comorbid and pregnancy associated conditions, N (%)
 Chronic hypertension 66 (0.6%) 3100 (0.7%) 19,924 (0.7%) 21,238 (0.9%) 15,717 (1.4%) < 0.001
 PIH 356 (3.3%) 12,369 (2.7%) 79,791 (2.8%) 83,689 (3.4%) 58,081 (5.2%) < 0.001
 Severe PIH/Eclampsia 71 (0.7%) 2369 (0.5%) 22,327 (0.8%) 27,832 (1.1%) 19,506 (1.8%) < 0.001
 Gestational diabetes 359 (3.3%) 17,911 (3.8%) 138,214 (4.8%) 145,951 (6.0%) 70,231 (6.3%) < 0.001
 Diabetes mellitus 35 (0.3%) 2236 (0.5%) 17,287 (0.6%) 20,877 (0.9%) 13,156 (1.2%) < 0.001
 Renal disease 27 (0.3%) 723 (0.2%) 3514 (0.1%) 3006 (0.1%) 2251 (0.2%) < 0.001
 Dialysis 0 (0.0%) 5 (0.0%) 99 (0.0%) 149 (0.01%) 134 (0.01%) < 0.001
 Organ transplant 0 (0.0%) 21 (0.0%) 140 (0.0%) 253 (0.01%) 368 (0.03%) < 0.001
 Severe chronic conditiona 2 (0.02%) 61 (0.01%) 660 (0.02%) 954 (0.04%) 1085 (0.1%) < 0.001
 Severe cardiac conditionb 9 (0.1%) 376 (0.08%) 2856 (0.1%) 3515 (0.1%) 3346 (0.3%) < 0.001
 Placenta previa 47 (0.4%) 1537 (0.3%) 14,011 (0.5%) 16,393 (0.7%) 7767 (0.7%) < 0.001
 Placenta previa after CS 10 (0.1%) 286 (0.1%) 2859 (0.1%) 3935 (0.2%) 1933 (0.2%) < 0.001
 Multiple gestation 132 (1.2%) 5704 (1.2%) 61,439 (2.2%) 78,841 (3.2%) 43,408 (3.9%) < 0.001
 High-risk patientsc 982 (9.0%) 41,527 (8.9%) 311,689 (10.9%) 337,059 (13.8%) 188,125 (16.9%) < 0.001
 Cesarean section 3150 (29.0%) 126,928 (27.2%) 819,661 (28.6%) 757,811 (31.0%) 340,778 (30.6%) < 0.001
Neonatal characteristics, N (%) (unless otherwise noted)
 Male 5534 (51.0%) 238,891 (51.1%) 1,463,488 (51.1%) 1,252,240 (51.3%) 570,285 (51.2%) < 0.001
 Birthweight 3317 (3000,3629) 3374 (3061,3686) 3371 (3041,3685) 3345 (3005,3660) 3319 (2965,3657) < 0.001
 GA, weeks 39 (38,40) 39 (38,40) 39 (38,40) 39 (38,40.) 39 (38,40) < 0.001
 GA categories, weeks       < 0.001
  GA < 28 weeks 42 (0.4%) 799 (0.2%) 8510 (0.3%) 13,045 (0.5%) 9632 (0.9%)  
  GA 28–31 weeks 79 (0.7%) 1682 (0.4%) 19,247 (0.7%) 29,233 (1.2%) 19,549 (1.8%)  
  GA 32–36 weeks 767 (7.1%) 29,030 (6.2%) 229,616 (8.0%) 236,880 (9.7%) 122,070 (11.0%)  
  GA 37–41 weeks 9607 (88.5%) 420,510 (90.0%) 2,473,357 (86.4%) 2,046,481 (83.8%) 921,954 (82.8%)  
  GA > 41 364 (3.4%) 15,347 (3.3%) 130,983 (4.6%) 116,966 (4.8%) 39,850 (3.6%)  
  1. Abbreviations: CA California, MO Missouri, PA Pennsylvania, IQR interquartile range, FFS fee for service, HMO health maintenance organization, GED general education diploma, PIH pregnancy induced hypertension, CS Cesarean section, GA gestational age
  2. aSevere chronic medical conditions: pulmonary hypertension, liver failure, dialysis, and organ transplant
  3. bSevere cardiac conditions: chronic heart disease, hypertrophic cardiomyopathy, acute/subacute endocarditis, constrictive pericarditis, tamponade, complete atrioventricular block, cardiac device in situ, atrial fibrillation, atrial flutter, congestive heart failure, mitral stenosis, atrial stenosis, dual valve disease, value replacement
  4. cHigh-risk patients have any of the listed maternal comorbid and pregnancy associated conditions