Antenatal Emergency Department and Inpatient Use Among Massachusetts Deaf and Hard of Hearing Women: A Retrospective Cohort Study

Background: Hearing loss is increasingly prevalent among younger adults and significantly impacts health and health care use. Deaf and hard of hearing (DHH) women have a significantly higher risk of chronic diseases, pregnancy complications and adverse birth outcomes compared to hearing women. The mechanisms, including health care utilization patterns during the perinatal period, remains not well understood. Methods We conducted a retrospective cohort study design to analyze 2002–2013 Massachusetts Pregnancy to Early Life Longitudinal data to compare antenatal inpatient and emergency department use between DHH (N=925) and hearing (N=2895) women with singleton deliveries. Matching was done based on delivery year, age at delivery and birth parity in 1:3 case-control ratio. Demographic, socioeconomic, clinical and hospital characteristics were first compared for DHH mothers and the matched control group using chi-squared tests and t-tests. Multivariable models were adjusted for socio-demographic and clinical characteristics. Results Among DHH women (N=925), 49% had at least one emergency department visit, 19% had an observational stay, and 14% had a non-delivery hospital stay compared to 26%, 14%, and 6%, respectively among hearing women (N=2895) during the antenatal period (all p<0.001). The risk of non-delivery emergency department visits (RR 1.58; p<0.001) and inpatient stays (RR 1.89; p<0.001) remained higher among DHH women compared to hearing women even after adjustment for relevant variables. Having four or more emergency department visits (7% vs. 2%), two or more observational stays (7% vs. 3%) and two or more non-delivery hospital stays (4% vs. 0.4%) prior to delivery were more common among pregnant DHH women compared to their controls (all P<0.001). Conclusion(s): The study findings demonstrate that DHH women during the use emergency departments and inpatient services at a significantly higher rate than their hearing controls during the antenatal period. A systematic investigation of the mechanisms for these findings, including healthcare-, patient- and provider-based factors, are needed. Health care providers should be aware of potentially heightened risk for pregnancy and birth complications among DHH women which are in part due to persistent social and healthcare barriers, including communication and language.