The Role of Socioeconomic and Hospital Factors in Access to Uterine Artery Embolization Versus Total Abdominal Hysterectomy for Postpartum Hemorrhage

Purpose: Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality in the US. This study investigates the role of socioeconomic factors in receiving uterine artery embolization (UAE) versus total abdominal hysterectomy (TAH) for management of PPH. The study considers how income level, insurance status, hospital type, and geographic region influence the likelihood of receiving UAE, a minimally invasive and uterus-sparing procedure compared to TAH.

Materials and Methods:
A retrospective analysis was conducted using data from the 2017 NIS Database. Patients diagnosed with PPH who underwent UAE or TAH were identified using ICD-10 diagnosis and procedure codes. The patient demographics of income and insurance status (Medicaid vs Private) were recorded alongside hospital characteristics (Urban teaching, Urban non-teaching, Rural) and geographic region (Northeast, South, Midwest, West). Chi-square testing was used to analyze the association of these factors against which procedure was performed.  



Results: Of the 730 women treated for PPH with UAE or TAH, UAE was performed in 220 patients (30.1%) while TAH was performed in 510 patients (69.9%). Chi-square tests revealed significant associations between income level, insurance status, hospital type, and geographic region with which procedure was performed for PPH. Higher-income patients were more likely to undergo UAE, while lower-income patients tended to receive TAH (χ2 (3, N = 716) = 29.05, p < .001). Patients with private insurance were also more likely to receive UAE as opposed to those on Medicaid (χ2 (1, N = 672) = 4.97, p = .025). Hospital type played a key role, with urban teaching hospitals more often performing UAE compared to than rural and urban non-teaching hospitals, (χ2 (2, N = 730) = 15.45, p < .001). Finally, regional differences were observed, with the Northeast and West utilizing UAE more than the South and Midwest, (χ2 (3, N = 730) = 8.58, p = .035).

Conclusion: Significant disparities exist in the use of UAE versus TAH for PPH with socioeconomic factors such as income and insurance type, hospital type, and geographic location influencing which procedure the patient receives. Lower-income patients, patients with Medicaid, and patients in rural settings are less likely to receive UAE despite its benefits of uterus preservation and shorter hospital stays {1}. These findings emphasize the need for targeted efforts to expand utilization of UAE, particularly in underserved areas where structural inequities may limit access to the procedure despite its advantages.